Increasing Access to Supportive Oncology Care Can Drive Health Equity

Andrew Leitner, MD, pain management physician and chair of the department of supportive care medicine at City of Hope, lists the key barriers to incorporating supportive care into value-based oncology care. He also discusses ways to provide patients from underserved or marginalized communities access to supportive care.

Leitner explored this topic further during his presentation, "Filling the Unmet Need for Supportive Care," at the Institute for Value-Based Medicine^® (IVBM) event held in Garden Grove, California in partnership with City of Hope last week.

Transcript

What are the key barriers to integrating supportive care into value-based oncology care?

One of the important barriers is the financial models of how supportive care is provided and how it's paid for. With the reimbursement landscape, much of the care that supportive care programs and services bring to bear can benefit health care outcomes, health care utilization, and things like cost avoidance, but they're not going to manifest in the same way with direct patient service revenues or direct reimbursement from payers, both public and private.

That's one of the fundamental barriers to organizing the work so that it is both health care impactful and cost-effective. You can align the benefits to the costs, either within a health care system or across the context of care that patients with cancer go through.

How can equitable supportive care access be ensured for patients from underserved or marginalized communities?

The question about equitable access is critical, and we believe that supportive care can be one of the major drivers of health equity, that it's not sufficient to have evidence-based best-in-class treatment modalities for cancer. We actually have to allow patients access to and utilization of those treatments. A lot of that depends on the type of support they're getting to get to those treatments, to stay on those treatments, to manage either the side effects or consequences of their disease or their treatments, and by approaching all patients from a care model standpoint.

That will help us elevate health equity, no matter what zip code you're from, no matter your socioeconomic or other determinants of health. You will be provided with what we consider the core universal needs for supportive care, and some of those are access to health education, access to resource coordination.

There's a number of community partners, but it's about connecting patients to those community partners for resource needs. It's navigation, how to navigate the health care system and navigate the collection of services that represent best-in-class cancer care and then psychosocial support.

We think that those 4 things are areas that all patients with a cancer diagnosis need some attention to, and creating a care model where all patients have access and utilization to those I think will do a lot to drive health equity outcomes.

Then, of course, there's a number of specialty programs and services, but those can be done in a disease-, risk-, or complexity-stratified approach. But that first group of 4, by making that a universal standard for all patients, can drive both the health care outcomes but also health equity.