Care Coordination Is the Top Investment Cancer Programs Can Make, Respondents Say

Reimbursements and drug costs are the top threats to future cancer program growth, while care coordination was named the best investment programs can make, according to findings of a new survey from the Association of Community Cancer Centers (ACCC).

The ninth annual Trending Now in Cancer Care survey identified current and emerging trends for US cancer programs. ACCC and the Oncology Roundtable conducted the survey in July and August 2018.

"ACCC's Trending Now in Cancer Care survey provides much-needed perspective on strengths and challenges experienced by cancer programs across the country," ACCC President Tom Gallo, MS, MDA, said in a statement. "Despite the barriers and pressures programs face, survey results show continued progress in delivery of patient-centered cancer care."

Reimbursement requirements from payers and cost of drugs and/or new treatment modalities each were identified as top threats by 48% of respondents. In addition, 40% cited uncertainties in drug pricing reform policies. Clinical standardization and symptom management were identified as top opportunities for cost savings with 54% each, while 45% said care coordination was most likely to yield a return on investment

Technology remained a boon and a burden for respondents. Only 3% of respondents said they have had no interoperability challenges. Of those who have had interoperability challenges and are addressing them, 41% are replacing the existing oncology module with the organization’s electronic health record (EHR) module; 34% are developing custom interfaces between the oncology module and EHRs; and 20% are extracting data a from source systems and depositing it in a data repository.

The respondents largely have a negative view of the impact EHRs have had on physicians and staff. Nearly 70% said EHRs have lengthened the workday, 59% said EHRs have somewhat or significantly worsened provider well-being, and 41% said EHRs negatively impact provider—patient interactions. However, despite these negative views, the respondents also saw the promise of EHRs and the positive impacts they have had. Overall, 69% said EHRs have significantly or somewhat improved care coordination.

The respondents of the survey highlighted the financial burdens on patients with cancer. Nearly half (49%) of respondents said a patient had refused treatment in the last 12 months because of financial worries, and 79% said they are very or somewhat concerned about patients refusing treatment because of financial worries.

A lack of reimbursement remains an issue for some services. The majority of respondents (70%) said a lack of reimbursement was the biggest barrier to using telehealth. Of those currently using telehealth, genetic counseling was the most popular service (35%) followed by oral chemotherapy adherence education and support (20%), and symptom management consults (19%).

Survey respondents also said supportive care services are paid for by the organization and through funds raised, since most of these services are not reimbursed by payers. The most popular support services offered are screening and nutrition services (95% each), spiritual and/or pastoral care (89%), navigation services and genetic counseling (88% each), psychosocial counseling (87%), smoking cessation counseling (86%), and financial advocacy (85%).

Overall, 81% of programs said they have dedicated financial advocacy staff to sign patients up for Medicaid (83%), obtain free drugs or co-pay assistance from manufacturers (81% each), or obtain drugs through private foundations (80%).

Survivorship care is on the horizon for the respondents. One-third (31%) said a survivorship clinic is a popular support service that is being added in the next 2 years and 33% said survivorship visits via telehealth is the most popular service being added in the next 2 years.