Investing in the Vital Role of a Cancer Care Coordinator

With policy changes coming through at a constant pace and the gradual move toward value-based care, integrating team-based care to break silos and allow a continued care transition is vital. But that can be a tough act, especially if your practice has not been planning for the change.

At the Association of Community Cancer Centers' (ACCC) 44th Annual Meeting & Cancer Center Business Summit, held March 14-16, 2018, in Washington, DC, panelists shared strategies that have helped their organizations adapt to value-based care while ensuring that they never lose sight of the patient at the center of it all. On stage were Marcus Neubauer, MD, vice president and medical director, Payer and Clinical Services, McKesson Specialty Health and The US Oncology Network; Tricia Strusowski, RN, MS, manager, Oncology Solutions, LLC; Barbara Tofani, RN, MSN, AOCN, administrative director, Hunterdon Regional Cancer Center; and Mark Krasna, MD, corporate medical director, Meridian Health System, Ocean Medical Center, who moderated the conversation.

Strusowski, a nurse by training who now works for a consulting company that advises oncology practices on value-based planning and care design and delivery, dived straight into the strategies that can enhance care coordination. “We need to reduce duplication and adapt more real-world strategies,” she said, which can enhance patients’ experiences with their care. “It’s also vital for practices to identify performance improvement initiatives for programs and services that may not be reimbursed.”

In discussing the care continuum, Strusowski highlighted the importance of patient flow and transitions. It is important to share that information with the entire team to decrease duplication of efforts, she said, adding that improving ways to communicate care information to patients and their families is vital to the process.

A study published in the December 2017 issue of The American Journal of Accountable Care^® found value in a model that used email-based care transitions between a hospital and primary care teams. Researchers found the practice improved patient attendance at follow-up visits, provider satisfaction, and work efficiency.

Strukowski then showed a very long list of members that should make up an ideal care team. “The care team should be multidisciplinary, and should include not just clinical and administrative staff, but patients and their caregivers should also be a part of the conversation,” she said.

She then suggested several strategies to increase the efficiency of care teams, including daily huddles, morning meetings, and discussing patient cases during tumor conferences. “An emphasis on staff training on core competencies, national guidelines, and health literacy is important,” Strukowski said, along with developing partnerships with other clinical practices and incorporating performance improvement strategies based on navigation and value-based cancer care metrics. At pre-determined stages, the care plan should include comprehensive patient assessment and patients should be referred to dieticians or counselors as required, she said.

Being cognizant of the patients' and their families’ situations, Strukowski said that the care team should provide them with shared decision-making aids instead of just handing them a volume of information on treatment options, which might be hard for them to read through and understand. She emphasized the importance of disease-site process mapping to review specific roles within the care team and identifying gaps in care. And, to come full circle, it’s important to match these with national quality metrics, she added.

Neubauer provided an overview of the Oncology Care Model (OCM), which funds practice transformation and demands:

• Patient navigation programs
• 24/7 access to care
• Implementation of the Institute of Medicine care plan
• Advance care planning (ACP)
• Team-based care
• Quality measurement reporting
• Using data to allow continuous learning.

During a webinar hosted by The American Journal of Managed Care^®, Kashyap Patel, MD, of Carolina Blood & Cancer Care, emphasized that OCM participation for his practice was not as big a challenge because they had been adopting some of those care practices over the years.

At the ACCC meeting, Neubauer explained that the Centers for Medicare & Medicaid Innovation, which has developed the OCM pilot reimbursement program, delivers data files to participating practices on a quarterly basis. “The raw data need to be converted to actionable information for practices," Neubauer said.

This information, of course, is vital for process improvement. Neubauer showed analyses of these data conducted by his organization that helped identify patients at high risk of hospitalization following chemotherapy, based on gender and age.

“Also, the data can provide a glimpse of risk of hospitalization following chemotherapy, based on disease type. It also gives us the ability to follow patients at higher risk if they have comorbidities,” he said. As the bottom line, it can significantly impact proactive case management to reduce these hospitalizations in these specific patient populations.

Evaluation of the impact of ACP on end-of-life choices by patients at their practices showed that 88% of those with ACP died at home or in hospice. In the non-ACP population, 77% died at home or in hospice care.

These data, when fed back into the system, can help practices implement positive changes and create a learning system.

Another growing concern within oncology is caring for survivors and coping with posttreatment health issues. Tofani discussed this as a last part of the puzzle of care coordination and directed the audience’s attention to the use of clinical practice guidelines to coordinate survivorship care.

“In less than 8 years, there will be 20 million cancer survivors in the United States. Why is survivorship care important?” Tofani asked. She noted that cancer survivors are faced with numerous issues, such as recurrence, secondary cancers, psychosocial effects of their disease and treatment, comorbidities due to other chronic diseases, and more.

Hunterdon, Tofani said, developed a survivorship program for better coordination of survivor care that was modeled on the National Coalition for Cancer Survivorship and the George Washington University Cancer Center toolkit and guidelines.

She said that studies have shown that primary care physicians (PCPs) and oncologists are confused about survivorship care and follow-up care, “which affects both the quality and cost of care.” Tofani said that Hunterdon has promoted their clinical practice guidelines and care coordination among specialists and PCPs as one of the first steps to improve survivorship care in their patient population.