DELIVERING QUALITY CANCER CARE: IMPROVING CARE COORDINATION AND ADDRESSING DISPARITIES IN A CHANGING ENVIRONMENT

Transcription

1 DELIVERING QUALITY CANCER CARE: IMPROVING CARE COORDINATION AND ADDRESSING DISPARITIES IN A CHANGING ENVIRONMENT Proceedings from the October 23, 2014 Regional Symposium

2 DELIVERING QUALITY CANCER CARE: IMPROVING CARE COORDINATION AND ADDRESSING DISPARITIES IN A CHANGING ENVIRONMENT On October 23, 2014, Genentech sponsored a regional symposium to explore critical issues impacting cancer care in the Philadelphia marketplace. While recognized as a hub for cancer research and care, significant health disparities exist across multiple populations in the greater Philadelphia region. These disparities, as well as challenges facing health systems across the country, contribute to unsustainable growth in healthcare costs. In efforts to address these concerns, the symposium focused on three principle themes: Advancing Patient-Centered Care to Improve Quality of Life and Outcomes Coordinating and Managing Cancer Care with Innovative Approaches Reducing Health Disparities Through Community-Based Care Initiatives Faculty and attendees addressed needs at a regional and national level regarding each topic and identified opportunities to collaborate to improve cancer care delivery. Participants represented a variety of stakeholder groups including hospital systems, health plans, government, academia, and employers. The agenda for the symposium was developed in collaboration with the Greater Philadelphia Business Coalition on Health. THE FACULTY Moderator: Neil Goldfarb President and Chief Executive Officer Greater Philadelphia Business Coalition on Health Speakers: Jenné Johns, MPH Director of Health Disparities, AmeriHealth Caritas Family of Companies National Medical Director, Aetna Inc. Hartford, Connecticut Don Liss, MD Vice President, Clinical Programs & Policy Independence Blue Cross Administrative Director Johns Hopkins Breast Center Baltimore, Maryland TOPICS The Patient at the Center: Survivorship in the 21st Century Improving Cancer Care Coordination: Whose Job Is It, and How Can We Do Better? Panel Discussion: New Models in Cancer Care Delivery Who is Really Accountable? Don Liss, MD Robert F. Tobin, RN, BSN, OCN Disparities in Health Care Challenges and Opportunities Jenné Johns, MPH Panel Discussion: Disparities in Cancer Care Where Do We Go From Here? Jenné Johns, MPH Don Liss, MD Robert F. Tobin, RN, BSN, OCN Robert F. Tobin, RN, BSN, OCN Director, Infusion Services, Penn Medicine 2. Delivering Quality Cancer Care: Improving Care Coordination and Addressing Disparities in a Changing Environment

3 HIGHLIGHTS Advancing Patient-Centered Care to Improve Quality of Life and Outcomes Central to the recent shift towards value-based healthcare is the desire to ensure the patient is at the center of all care decisions and conversations. Lillie Shockney, RN, BS, MAS, a two-time breast cancer survivor and a leader in the field of cancer treatment, shared her personal journey and the work she has done to improve care delivery for cancer patients from the time of diagnosis through survivorship. Shockney recommended several strategies for various healthcare stakeholders to enhance the quality of their patients care across the cancer journey. These included Creating a specialized oncology care team that emphasizes patient participation in healthcare decision making. Training current and future internal medicine physicians and nurse practitioners in cancer survivorship care, including the management of side effects and monitoring for cancer recurrence. Ensuring advanced care patients maintain a reasonable quality of life by discussing treatment options and goals of each regimen, as well as providing emotional, physical, spiritual, financial, and legal support to patients and their families. Shockney described these activities as helping patients achieve a good death by focusing on quality of life instead of quantity of life. Providing a process to transition cancer patients into long-term survivorship by developing patient-centered survivorship care plans and ensuring community providers are able to continue individualized follow-up care. What is it that our patients deserve and need? They need easy access to specialists who are truly masters at diagnosing and treating the kind of cancer that they have... You want individuals that specialize in the kind of cancer that you have... The patient deserves the right treatment in the right setting with the right tools at the right time. Implementing employer-based cancer awareness and prevention programs. Shockney described the Johns Hopkins Medicine initiative, Managing Cancer at Work. This initiative enables organizations to help their employees prevent cancer, recognize the early warning signs of the disease, and manage cancer treatment. Program components include: a personalized online employee portal, a supervisor s and manager s toolkit, and an oncology workplace nurse navigator., also highlighted the following initiatives underway at Aetna that seek to improve health outcomes by focusing on patient needs and desires: Innovent Oncology, a cancer care management program launched by Aetna, McKesson Specialty Health, and Texas Oncology, uses the medical home model to promote evidence-based, patient-centered, cost-effective treatments. Results of a two-year pilot included fewer cancer-related emergency room visits, in-patient admissions and hospital days. 1 The Aetna Compassionate Care SM program addresses the needs related to end-of-life care by offering support and education on options available to patients and their families. 3. Delivering Quality Cancer Care: Improving Care Coordination and Addressing Disparities in a Changing Environment

4 Coordinating and Managing Cancer Care with Innovative Approaches The patient-centered, holistic approach to cancer care delivery requires providers to effectively coordinate care from one treatment episode to the next and across healthcare settings. According to Klein, improved coordination of patient services has the potential to reduce cancer care costs and improve outcomes. Patient Centered Oncology Management Can Drive Access and Care Choices 2 PROVIDER COLLABORATION Effective oncology management can help mitigate the impact of rising costs MEMBER ENGAGEMENT At stake are the results of good oncology management Medical Advances Technology Inefficient Care & Use of Services Quality of Care Productive Return to Work & Wellness Overall Value Aetna has developed a patient-centered oncology management strategy to be an assist to the [oncology] practice rather than an impediment. Klein noted that coordination with providers is integral to achieving patient-centered care. As part of this strategy, Aetna has put in place an oncology medical home model and a team of oncology nurse navigators. Aetna s Oncology Medical Home model strives to improve coordination of care through enhanced communication, patient education and shared decision making by: Directing patient care through a dedicated physician, who is responsible for providing or arranging specialized care with other members of the oncology team. Optimizing the care plan and facilitating communication between providers using clinical decision support tools. Incentivizing providers to support goals designed to improve care coordination, outcomes, access, and cost efficiency. Every patient has an ongoing relationship with a personal physician. That physician leads a team, and that team takes responsibility for the care of the patients. Klein also highlighted how Aetna s oncology nurse navigators I. Klein aim to close the gaps patients encounter throughout their care. Nurse navigators coordinate care with members of the oncology team and work directly with patients and family to provide education and information that otherwise may not be properly communicated. From a payer perspective, nurse navigators play an especially critical role in helping patients understand their insurance coverage and how it may affect their treatment plan. 4. Delivering Quality Cancer Care: Improving Care Coordination and Addressing Disparities in a Changing Environment

5 Klein s presentation led to a discussion where panelists explored additional opportunities for stakeholders to improve the coordination and management of cancer care including: Developing a coordinated strategy for providing follow-up care to the growing population of cancer survivors. Faculty recommended that the survivorship care model include enhanced primary care physician (PCP) engagement and standardization of care to some extent. Creating incentives for providers to deliver improved coordination throughout the care continuum (e.g., communicating patient preferences and care plans; participating in end-of-life discussions with patients and their families). Educating and enabling oncology nurse navigators to play a larger role in the patient s cancer journey through providing appropriate tools, training, and support. To ensure all needs are being met, solicit input from the entire cancer care team, including physicians, community resource providers, patients and family members. o Standardized scripting and other reference materials were highlighted as helpful tools in supporting nurse navigator management intervention since currently many hospitals, health plans, and provider groups have separate navigator teams. o The Academy of Oncology Nurse Navigators (AONN) was noted as a valuable resource. The organization provides monthly, special-topic webinars and interactive learning tools and also plans to offer nurse navigator certification. Each patient, no matter what type of cancer they have, should have a nurse navigator at their side who specializes in the type of cancer that they re experiencing. That individual should be there to provide education, not just to the patient but also to the family members who are caregivers for them at home. Reducing Health Disparities Through Community-Based Care Initiatives The challenge of care coordination is compounded by the continuing problem of disparities in and access to quality healthcare. Health disparities persist in the United States and remain particularly widespread among members of certain racial and ethnic minority populations. Other social determinants, including socioeconomic status, education, and urbanization, also directly and indirectly affect the health and well-being of individuals and communities. Jenné Johns, MPH, cited that in the Philadelphia region, the estimated life expectancy for individuals in suburbs is up to six and a half years higher than those who live in the city proper, where one in three residents live below the poverty line. 3,4 In addition to the human costs, health disparities take a heavy toll on the economy. Between 2003 and 2006, the combined costs of health inequalities and premature death in the United States were $1.24 trillion. 5 The symposium looked at current efforts and future strategies to reduce health disparities at both the local and national levels. The Affordable Care Act contains provisions that address health disparities, as outlined in the table below. Affordable Care Act Provisions that Address Health Disparities Data Collection Section 4302 of the law requires that federally funded healthcare programs collect, report and monitor data (on race, ethnicity, sex, primary language, disability status, and geographic location) to better address the needs of underrepresented population groups. Medicaid Expansion To date, 28 states have expanded eligibility for Medicaid, providing a significant opportunity to increase health coverage among low-income and disabled individuals Delivering Quality Cancer Care: Improving Care Coordination and Addressing Disparities in a Changing Environment

6 As these ACA provisions are implemented, organizations continue to work through challenges. Specific to the data collection requirement, the faculty cited the following opportunities for improvement: 1) gaining support from hospital and health plan CEOs; 2) developing interoperable and secure data systems; 3) and training staff on how to collect data with cultural competence and sensitivity. The faculty also highlighted the following initiatives that expedite the removal of health disparities and support the implementation of the ACA: According to Johns, the National Standards for Culturally and Linguistically Appropriate Services provides healthcare organizations and individual providers with guidance on how to enhance communications with diverse populations. Shockney added that the Johns Hopkins Center to Reduce Cancer Disparities coordinates community-based outreach and cancer screening programs. Additionally, the Johns Hopkins Breast Center conducts education programs at local health fairs, as well as church- and school-related events, which allow care providers to communicate directly with and tailor educational messages for different populations. Simply put, [health equity] is raising the bar for people who have been marginalized, disenfranchised, discriminated against, left behind or left out. And I d like to remind us all that it is our job, as clinicians, as providers and employers, to help people reach that health equity goal. J. Johns The discussion identified the following key strategies to reduce disparities in cancer care: Partnering with professionals from a range of business sectors that may directly or indirectly influence population health (e.g., transportation, labor, education, and housing) to ensure that community needs are identified and barriers are addressed. Creating the infrastructure to help patients and caregivers access the resources that are available to them (e.g., drug discount cards, social assistance programs). Leveraging Twitter, Instagram and other social media platforms to engage younger adults in their own care (e.g., using hashtags to promote cancer screening and prevention). Utilizing outreach programs to educate underserved populations, including dispelling myths and misconceptions about cancer and reducing the stigma and fear that surrounds the disease. Engaging community health workers through focus groups, discussion forums, and other venues as a means to better understand the health needs of the different patient populations. If you rely on patients to [access healthcare resources], a lot of them don t have the tools that they need in order to be able to do it, not just from a technology perspective, but just from an understanding perspective. R. Tobin We certainly need to undo the myths and instill the facts because we do know that the underserved populations are fearful of the word cancer... So being able to undo those myths cannot be understated, and it has to be done again and again and again. It isn t just one message and it s subsequently solved. 6. Delivering Quality Cancer Care: Improving Care Coordination and Addressing Disparities in a Changing Environment

7 Looking Forward As the healthcare landscape continues to change, it is becoming increasingly important to find new and innovative ways of delivering high-quality, cost-efficient cancer care. Multi-stakeholder collaboration is essential to achieving this goal, and the symposium explored initiatives and strategies for payers, providers, patients and employers to bring the patient to the center of care delivery and improve access for all patients. Community-based partnerships will be particularly valuable in addressing health disparities. Moderator Neil Goldfarb encouraged attendees to continue creating opportunities to work together and invited them to participate in new initiatives led by the Greater Philadelphia Business Coalition on Health, including one that addresses disparities in cancer screening and cancer treatment: Hopefully, together, we can not only address health disparities but also improve processes and outcomes across the spectrum of cancer care. References: 1. Hoverman JR, Klein I, Harrison DW, et al. Opening the black box: the impact of an oncology management program consisting of level I pathways and an outbound nurse call system. J Oncol Pract. 2014;10(1): Adapted from: Klein I. Improving Cancer Care Coordination: Whose Job Is It, and How Can We Do Better? [PowerPoint slides]. Aetna Inc Metropolitan Philadelphia Transit Lines. Commission to Build a Healthier America. Robert Wood Johnson Foundation Available at: Accessed February 5, Community Health Assessment. Philadelphia Department of Public Health Available at: Accessed February 12, LaVeist TA, Gaskin DJ, Richard P. Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 2011;41(2): Status of State Action on the Medicaid Expansion Decision. The Henry J. Kaiser Family Foundation. Available at: Accessed January 27, Delivering Quality Cancer Care: Improving Care Coordination and Addressing Disparities in a Changing Environment 2015 Genentech, Inc., So. San Francisco, CA MCM/021815/0057