By Sibel Blau, MD
As highlighted in ASCO’s State of Cancer Care in America: 2017 report, great progress has occurred in the improvement of survival of patients with cancer with the invention of new treatment modalities and the introduction and wide use of "-omics" to diagnose and customize patient care. As a result, there are increasing numbers of cancer survivors—15.5 million in the United States alone. This number is expected to grow by more than 30% in the next 10 years.
The opportunities to improve cancer care are here, but the cost is increasingly too high. The challenge is to figure out a way to reduce the cost of the new interventions while providing high-quality care and taking advantage of the advances in cancer care. Payers are very motivated to find ways to balance the cost to improve quality and patient satisfaction. Patients would like to access diagnostic methods that may improve their outcomes and allow them to receive customized treatment. Oncologists want to provide the best patient care and to advance cancer research by increasing participation in clinical trials.
Oncologists must join in the transformation of the cancer care delivery system to help create a system that will work for everyone. As a community oncology group, we at Northwest Medical Specialties (NWMS) started realizing the need for change several years ago. Working with commercial payers and Medicare, NWMS now treats more than 70% of its patients under a Value-Based Care (VBC) model. Doing this in a mid-size community oncology practice is not easy. We had to dedicate our entire practice to achieving the required measures. We created new positions, such as Patient Care Coordinators (PCC) and triage nurses, and hired more social workers and financial counselors. We added longer and weekend hours to see sick patients to avoid emergency department admissions.
While resources from payers and the Center for Medicare and Medicaid Innovation (via the Oncology Care Model) helped to support us, this transformation required more than just money: it also created a major burden for the clinicians who are already required to do more in electronic health records. Now, there is a greater administrative burden with hours spent on prior authorizations. The frustration and dissatisfaction level among clinicians and employees increased in our practice during this period.
The State of Cancer Care in America report documents this issue in detail, showing that increasing administrative burdens and cost-sharing measures are draining resources and squeezing the time spent with patients. On average, medical practices complete an average of 37 prior authorization requirements per physician weekly—taking an average of 16 hours of clinician time.
To improve communication, we created an oncology medical home team that involved clinicians, managers from different disciplines, and other employees. We met weekly over a 2-year span, and continue to meet every other week. PCCs played a major role in communicating not only with the clinicians, but with everyone who provided care for a given patient. This close interaction among the PCCs and others in the practice provides better patient flow, increases patient satisfaction, and reduces errors.
The result of this intense work and effort was to receive our first-year data from commercial payers and our first 6-month data from OCM showing improvement in every measure, including the reduction in emergency department admissions, hospitalizations, and readmissions. We also reduced costs in all areas. Recently, the Association of Community Cancer Centers (ACCC) recognized our work with a 2017 ACCC Innovator Award, which recognizes forward-thinking strategies for the effective delivery of cancer care.
Creating a new model requires money, time, and skill. However, one of the major requirements for success is the sharing of knowledge and learning from others. As a founding member of Quality Cancer Care Alliance (QCCA), our oncology practice had the advantage of learning from others and sharing tools that would not be otherwise available. QCCA works as a collaborative group to enhance its members’ knowledge, to share experiences, expertise, and tools. We believe that we need to depend on each other to create the best program to deliver the best cancer care. In the beginning of this transformation, our practice visited the Center for Cancer and Blood Disorders in Fort Worth, Texas (another QCCA site) to adopt their triage pathways and to learn about their oncology medical home model.
This is an example of how, as ASCO members, we can share knowledge, experience, and expertise with each other with the help of ASCO. While this transformation from volume to value is difficult and the future is unknown, once done correctly, the end result is wonderful for patients, clinicians, and oncology practices. When oncologists are involved and work with ASCO and other organizations, there is hope for improving the cancer care delivery system for everyone.
Dr. Blau is a medical oncologist who has been in clinical practice since 2001. In addition to her work as a breast oncologist, Dr. Blau has taken leadership roles in developing breast cancer programs of excellence in her region. She is very involved with clinical research programs as a PI and sub-PI on many clinical trials at Northwest Medical Specialties (NWMS) and is the head of the Precision Medicine program. She is a member of Oncology Medical Home Committee at NWMS, working on value-based programs. She is one of the founding members and currently the chairperson of Quality Cancer Care Alliance, president of the Washington State Medical Oncology Society, and medical director at NWMS.