National Oncology Conference: Framing Issues & Finding Answers

ACCC President Steven D’Amato, BSPharm, BCOP, welcomes attendees to National Oncology Conference

by Amanda Patton, ACCC, Communications

Featured speaker Peter Bach, MD, MAPP, addressed a packed room in the opening session of the ACCC National Oncology Conference on Oct. 22, in Portland, Oregon.  Dr. Bach is Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center.

Dr. Bach’s remarks centered on four prime issues challenging oncology today: the cost of cancer drugs, the need for oncology to do a better job on comparative outcomes research, the 340B drug pricing program, and the importance of incorporating end-of-life care into cancer program services.

Finding a rational way to address drug costs matters on both the macro level [in terms of the impact of healthcare costs nationally] and on the micro level at point of care when “drugs are being left at the pharmacy counter because patients can’t afford the copay,” he said.

 

Conference sessions throughout the day focused on challenges and innovative solutions that can have powerful micro- and macro-level impacts on cancer programs and providers, and the patients they serve: From “how to” sessions on benchmarking salaries, applying lean principles for staffing, establishing a virtual tumor board, distress screening, and preparing for alternative payment models, and more, to a big picture session on Advancing Quality—from Oncology Medical Homes to Integrated Delivery.  One cross-cutting takeaway message: work across disciplines and siloes—think about how to collaborate outside the box and across the care continuum.

Stay tuned for more conference highlights. Follow conference on Twitter at #ACCCNOC.

Strength in Numbers

By Amanda Patton, Manager, Communications, ACCC

By the time ACCC’s Annual National meeting wrapped up this week, attendees had heard plenty of numbers. Here is just a small sampling:

7.1 million     Estimated number of enrollees under the ACA’s health insurance marketplaces
70%                  Percent of plans on insurance exchange that are considered “narrow networks”
30                     Number of states that have now passed oral parity legislation
13.7 million   Current number of cancer survivors in the U.S.
1.5 million     Number of new cancer cases diagnosed annually
18%                  Percent of U.S. population that will be Medicare eligible by 2020
17                      Number of times Congress has passed a “doc fix” to the SGR

All these figures and more added up to some overarching themes from this year’s meeting sessions:

Strength in numbers is needed to make the voice of community cancer care heard on Capitol Hill. “At the end of the day, I think we need more clinical voices in the policy setting,” said keynote speaker Kavita Patel, MD, of  the Brookings Institution. “You don’t want Medicare or Congress thinking about cancer care without [your voices being heard].”

Patient-centered care requires open communication. In Tuesday’s panel on “What Are the Costs and Where Is the Value in Cancer Care?” panelists agreed that discussion about value in cancer care is complex but must be patient-centered. “For patients, value has a number of different meanings,” said panelist Nancy Davenport-Ennis of the Patient Advocate Foundation. “Patients want to have open dialogue with physicians about what the options are and how they are going to pay for this [treatment].”

The need for good communication with patients was also part of an earlier panel discussion on Multidisciplinary Care in Oncology. Smaller hospitals and cancer programs trying to create multidisciplinary programs should first look to the relationship that needs to exist between patients and the team, said panelist Tom Kean, MPH, of C-Change. It’s important to ask: “What does the patient value?”

The future oncology care delivery structure & workforce will look different.  Given the perfect storm brewing of escalating costs, a growing demand for oncology services, and a projected future shortage of oncologists, the way we deliver cancer care will have to change. Several presenters circled around the medical home (possibly in combination with some type of pay-for-performance) as potentially a good fit for oncology—in part because many cancer centers are already providing the services encompassed by this model. And several sessions touched on how the cancer care workforce will have to change to meet the projected demand. This new “care force” will not only include more non-physician providers, but also is likely to have non-clinical care providers and make increased use of community resources.

One shift that is already underway in some cancer programs is careful assessment of skill sets. Multidisciplinary Care in Oncology panelist Marie Garcia, RN, OCN, said, for example,  her practice took a close look at the skill set needed to provide survivorship services. For their survivorship program was a nurse practitioner needed? Could the position be filled by a nurse? Or a patient navigator? “In a value-based world, you need everyone on the team performing at the top of their licenses,” said co-panelist Mark Soberman, MD, MBA, FACS.

We must be the change. Across sessions the recurrent message was that cancer providers need to be proactive. It’s fine to start small, but start now, assess ways to demonstrate value, explore new payment models, and work more collaboratively with payers, providers, and community resources.

Navigation: Meeting Standards, Engaging Patients, Providing Value

by Amanda Patton,  ACCC Communications

Across sessions at the 30^th National Oncology Conference in Boston a common thread of discussion was the need for cancer programs to demonstrate quality and value while providing patient-centered care.

Commission on Cancer (CoC) standards, the Affordable Care Act (ACA), and the recent Institute of Medicine (IOM) report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, all place emphasis on the need for patient-centered care and for increased patient engagement.

Accreditation from the Commission on Cancer is a long-standing measure cancer programs can use to demonstrate quality to payers, providers, and patients. It’s well known that for 2015, the Commission on Cancer is phasing in new standards for patient navigation (Standard 3.1), psychosocial distress screening (Standard 3.2) and survivor care planning (Standard 3.3).

Two sessions on Friday, Oct. 4, offered ample evidence of how patient navigation services can enhance patient engagement, remove barriers to care, improve the patient experience, and demonstrate value and quality–and in the process, help meet CoC standards.

Speaker Mandi Pratt-Chapman, MA, from the George Washington University Cancer Institute (GWCI) described how their 2013 ACCC Innovator Award-winning patient navigation program addresses all three of the above CoC standards. Plus, GWCI has helped to develop a Citywide Patient Navigation Network that connects primary, tertiary care, and community-based organizations, helping to combat fragmentation of care.

For cancer programs just initiating navigation services, Pratt-Chapman offers the following “Navigation 101” tips:

• Conduct a needs assessment to inform program development
• Establish a referral process
• Establish rapport with patients and providers
• Know your scope of practice
• Document encounters
• Track outcomes
• Know national and local resources.

GWCI’s approach to addressing psychosocial distress screening included creating a Psychosocial Distress working group, identifying appropriate points along the care continuum to assess for distress, developing a Distress Screening policy, and creating a psychosocial distress screening triage plan.

With services that extend into survivorship, navigators can help empower patients and teach them to become their own healthcare advocates.  Pratt-Chapman shared a number of resources that GWCI has developed related to patient navigation and cancer survivorship, including a Survivorship Care Plan Template, an Executive Training on Patient Navigation and Survivorship program, and an e-learning series on cancer survivorship for primary care physicians. Additional resources are available from the National Cancer Survivorship Resource Center, a collaborative effort between the American Cancer Society and GWCI, funded by the Centers for Disease Control and Prevention. More information is available at www.gwcancerinstitute.org.

In a complementary presentation, Carol Santalucia, MBA, Vice President, CHAMPS Patient Experience, discussed the positive impact of navigation on the patient experience, defined as the sum of all interactions between the patient and the organization across the continuum of care. Santalucia discussed the roles of three different types of navigators: clinical, lay, and insurance (or financial). Generally speaking, clinical navigators assist with treatment and prevention-related tasks; apply clinical knowledge to help patients understand their treatment and care options and discharge instructions, and provide individual, family, and caregiver counseling. Insurance navigators help patients with the often complex and difficult issues around the cost of care. Lay navigators help coordinate screenings and appointments, connect patients to resources and information in the healthcare system, and remove barriers to accessing care in a timely manner.

Santalucia urged attendees to consider adding lay navigators to their existing clinical navigation programs, as lay navigators’ focus on providing information, finding resources, and coordinating care can dramatically improve the patient experience while freeing clinical navigators to focus on treatment concerns.

Navigation can also have a positive impact on the bottom line. As an example, Santalucia described a pilot lay navigation program that paid for itself in about four months and improved both patient outcomes and satisfaction.

Both sessions provided strong support for the role of patient navigation in enhancing patient engagement, helping overcome barriers related to fragmentation of care, improving the patient experience, and streamlining access to services.