In 2023, the Association of Community Cancer Centers (ACCC) hosted a series of 2-hour interactive sessions at the ACCC 49th Annual Meeting & Cancer Center Business Summit (#AMCCBS) to collect insights and solutions into eight key areas. Discussions were captured in Trending Now in Cancer Care Part 1 and Trending Now in Cancer Care Part 2. Below are highlights from Trending Now in Cancer Care Part 1.
Staffing Models & Workforce Challenges
With most cancer programs facing workforce shortages, improving recruitment and retention, addressing burnout, and improving morale and resiliency are top of mind for leadership at all levels. To help in these areas, attendees offered many suggestions, including these two no-cost or low-cost tips:
1. Begin meetings with a moment of gratitude and regularly ask staff to share their "why" for working in oncology. Remember, empathy and authenticity are necessary to engage in meaningful dialogue.
2. Recognition should be structured and ongoing; it can also be as simple as an extra day of PTO (paid time off) or an Employee Appreciation Day.
For cancer programs with some level of buy-in and resource allocation, attendees shared numerous ideas, including:
* Hire additional advanced practice providers (APPs), including medical assistants (MAs) and pharmacists to help with physician shortages and/or coverage gaps. APPs can take over many tasks managed by physicians, including chemotherapy orders, patient education, and side effect and symptom management.
* Create funding streams to build percentages of time that staff can devote to programs and processes that address burnout and build resiliency so it's not just activities that staff work on in the evenings or on weekends.
Patient Engagement Strategies
Educating and empowering patients so they trust and feel connected to their cancer care team can improve access, health equity, and patient outcomes-particularly for at-risk and underserved communities. Attendees shared numerous strategies to help cancer programs and practices engage with patients and families, including:
* Understand that delivering cancer care to at-risk and underserved patients requires trust. Building trust requires asking for input from the community on the best locations to conduct outreach and screening and picking dates that work best for the schedules and lifestyles of those who live in that community. Start small with two or three screenings events per year.
* Hold cost-of-care discussions at initial visits so that patients understand if treatment needs to be delayed due to prior authorization or other payer policies.
* Partner with patient advocates and community health workers. Advocates understand the culture of the patient and the health care system and can assist with health literacy, benefit issues, social determinants of health, and barriers to care. Community health workers are trained and certified to go into their communities and help health care providers build trust in that community. While not clinicians, community health workers partner with providers to educate communities about cancer and can be especially useful in rural communities where providers and resources are often scarce.
Strategies to Mitigate Payer-Driven Challenges
Payers continue to implement strategies, such as prior authorization, step therapy, and white- and brown-bagging, that are burdensome to providers and patients, often having a negative impact on clinical decision-making and patient outcomes. Attendees shared practical strategies to help cancer programs mitigate these challenges, including:
* When entering contract negotiations, providers should educate payers about the number of new oncology drugs that are coming to market, the high price tags of these new therapies, and the benefits these therapies have in terms of increased life expectancy and/or improved quality of life.
* E-prior authorization tools can streamline prior authorization workflows; however, provider data are critical. Documentation of medical necessity and adherence to guidelines are key, and cancer programs should ensure these data are verified and reviewed by providers before prior authorizations are sent out.
* Clear-bagging, where the drug comes through the pharmacy benefit, is an option to brown- and white-bagging. While this practice means lower reimbursement to providers compared with the amount received under the medical benefit, clear-bagging is generally accepted because it negates custody concerns as the drug is controlled at all times by providers.
New Care Delivery Models
COVID-19 accelerated adoption and expansion of new care delivery models, such as virtual visits and remote patient monitoring, which often allowed providers to better meet the needs of underserved patient populations. Attendees shared key insights into new models of care, including:
* Successful implementation and delivery of telehealth requires cancer programs to understand what services can best be delivered virtually, for example, palliative care, nutrition, and genetic counseling, and what patients can most benefit from telehealth services, for example, those residing in rural locations or those facing transportation barriers.
* Patient selection is key to successfully implementing remote patient monitoring. Cancer programs need to identify patients with the right level of acuity or a specific patient population that they feel will benefit from this technology. Staff engagement and education are also critical to success. Clinicians and staff must buy in to this care delivery model, including trusting and being able to act on electronic patient-reported outcomes (ePROs).
* A community paramedicine model allows providers to evaluate patients while they remain in their home, addressing acute symptoms before patients are sent to the more costly emergency department or before patients come in for an urgent visit at an outpatient cancer center (Oncol Issues 2022; https://www.accc-cancer.org/docs/documents/oncology-issues/articles/2022/v37-n3/.
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