Experts Emphasize the Value of Cancer Care Integration at ACCC Meeting

Care coordination and integration of multiple care teams are vital to a seamless experience for a patient being treated for cancer. It can help break down silos and allow for a continuum of care, which can, in turn translate into improved outcomes.

At the Association of Community Cancer Centers’ (ACCC) 44th Annual Meeting & Cancer Center Business Summit, March 14-16, 2018, in Washington, DC, panelists discussed the most powerful forces that are reshaping cancer care to be more multidisciplinary.

Thomas Asfeldt, MBA, RN, director, Outpatient Cancer Services, Sanford Cancer Center, joined Robin Hearne, RN, MS, director, Cancer Services, The Outer Banks Hospital; Kavita Patel, MD, MS, FACP, nonresident senior fellow, Brookings Institution; and outgoing president of ACCC Mark S. Soberman, MD, MBA, FACS, Monocacy Health Partners, on this panel.

“Cancer care continues to get complex,” Soberman said. He said that cancer care was already at a point where patients and primary care physicians (PCPs) needed help to deliver the care, and “care teams keep getting complicated.” However, he noted that care coordination is typically not reimbursed, neither are psychosocial care or social work services. “How do we develop platforms that can do all this while ensuring that the patient remains at the center?” Soberman asked.

In his opinion, community-based providers need to collaborate among themselves, as well as with health systems, to better coordinate their patient’s care and provide them with options. An important consideration, in Soberman’s opinion, is “How do we assign responsibility for survivorship care? Does it require training the PCPs?”

Asfeldt has helped build Sanford Cancer Center’s cancer program from the ground up. He informed the audience on the struggles, the changes, and the outcomes that he has witnessed along the way. He particularly highlighted their cancer extenders program, which stemmed out of a grant from ACCC and the BMS Foundation.

“We are currently testing the Oncology Care Collaborative Model at 7 sites," Asfeldt said. "The program was developed from an assessment tool for optimal care coordination. Oncology care includes a team of researchers, radiation oncologists, medical oncologists, pharmacists, nurse practitioners,” along with others. “Therefore, integrating [the services of these providers] is important."

At Sanford, champions and commitment among team members are important to help ensure care integration, Asfeldt said. The champion does not necessarily need to be a physician, he emphasized—it can be a nurse navigator, a clinical pathologist, a social worker, or a dietitian. “If someone is not a natural champion, you can try to nurture them, because without a champion, such programs cannot fly,” he added.

Providing a contrast perspective for a smaller, more rural practice, Hearne presented a case study of a program to advocate a prospective peer review for radiation oncology treatments, “Which is difficult for rural [health] systems like ours.”

“Our radiation oncologist championed a project for prospective peer review across our region and he brought in experts from the various centers to develop a standard framework for care,” she said. The peer review group emphasized the importance of evidence-based guidelines, and developed metrics to measure the impact of implementing the process over time. “This was then turned into a scoring tool. We achieved 100% prospective peer review over a period of 1 year and documented a reduction in treatment variability, and better outcomes,” Hearne said.

How do you find the resources for this? Patel asked.

“We can bucket resources,” Soberman said, “such as for people (navigators, coordinators, information technology, etc), technology resources (platforms needed to communicate, data, etc), or site of care.” Additionally, if there are prospects for collaborations or affiliations with other practices or health systems, it presents opportunities for outside resources, he added.

Motivation can be a big driver, Asfeldt said, adding that the scaling up is not a big concern for an integrated cancer care team. There also needs to be clarity around the depth of services that a cancer care team can provide in-house and which services would require either collaboration with another practice or a referral.

Resource allocation decisions require evidence-based guidance on what adds value to the care and services. “We need to make sure our upper management understand the appropriate value of the cancer service line,” Asfeldt said, which will assist with informed decisions.

He also highlighted the importance of philanthropy as an important funding resource. “Philanthropy should be an active part of your revenue stream. One of our other goals is to get 25% of our revenue from areas that are not taking care of sick people, which includes offering weight management programs, licensing on innovation, and commercial real estate.” Sanford Health System’s CEO has been emphasizing this avenue as a resource stream across their health system.