"Better care coordination has been identified by the Institute of Medicine (IOM) as one of multiple national priorities for action to improve the quality of healthcare.2 Care coordination can take many forms—follow-up on medication adherence, appointment monitoring, hiring of clinical coordinators, establishing after-hours portals, holding care team consultations—and oncologists have been working harder on these points, spurred in part by the OCM and CMS’ growing, incentive-based emphasis on value-based care. Many factors impair coordination and contribute to poor outcomes. These range from poor follow-up on testing to electronic health records that don’t synchronize with other digital platforms.3
Privately developed models of care that emphasize better coordination have also emerged. The oncology patient–centered medical home has been touted as being able to save million per physician per year. It can align systems and resources and thus reduce fragmentation, support shared decision making, and better control costs, according to chief architect John D. Sprandio, MD, chief of medical oncology and hematology at Consultants in Medical Oncology and Hematology and director of the cancer program at Delaware County Memorial Hospital, in Upper Darby, Pennsylvania.4
However, as with any transformative internal revamp, the model requires “nothing short of a substantial, disruptive, and coordinated response by the practice to reengineer the delivery of care,” as well as the creation of a sustainable business model that can be achieved only by actively engaging with payers in the development of new payment methodologies, according to Sprandio. Lighter measures are also available to achieve coordinated care.
One way is to hire nurse navigators, according to Mark Krasna, MD, who spoke on the subject at the ACCC’s 2018 annual meeting. Nurse navigators work with staffers and doctors at all levels in oncology practice and can help achieve consensus on an individual patient’s care, Krasna stated at the event. He added that care coordination reduces unnecessary x-rays and magnetic resonance imaging, among other tests, and puts practices in good stead with payers. He also noted that patient satisfaction is higher at facilities that work hard on aspects of care coordination. From a business perspective, these satisfied patients may help boost referrals by telling friends and family about their experience with the practice, Krasna noted.5
Care coordination cannot help but be beneficial for patients, Oyer added. A well-oiled system for patient referrals can add to the business benefits of coordination, which is helped along if oncologists pull out all the stops. “When you have a streamlined referral process, that is attractive to patients, and they are more likely to choose you to provide their care,” he said.
In a sense, care coordination is also workforce optimization, and that is good for running a business, Oyer said."
1Association of Community Cancer Centers 2018 survey finds multiple barriers to cancer program growth [news release]. Rockville, MD: Association of Community Cancer Centers; January 16, 2019. accc-cancer.org/home/news-media/press-releases/news-template/2019/01/16/association-of-community-cancer-centers-2018-survey-finds-multiple-barriers-to-cancer-program-growth. Accessed May 22, 2019.
2Initial national priorities for comparative effectiveness research. National Academies website. nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/ComparativeEffectivenessResearchPriorities/CER%20report%20brief%2008-13-09.pdf. Published June 2009. Accessed May 22, 2019.
3Weaver SJ, Jacobsen PB. Cancer care coordination: opportunities for healthcare delivery research. Trans Behav Med. 2018;8(3):503-508. doi 10.1093/tbm/ibx079.
4Sprandio JD. Oncology patient-centered medical home. J Clin Oncol. 2012;8(35):47s-49s. doi: 10.1200/JOP.2012.000590.
5Cryts A. Improve care coordination in cancer care: 2 key focus areas. Managed Healthcare Executive. March 16, 2018. www.managedhealthcareexecutive.com/leukemia-and-lymphoma/improve-care-coordination-cancer-care-2-key-focus-areas. Accessed May 22, 2019.