June 14, 2016
Integrating Cancer Care across Oncology Specialties
Cross-specialty collaboration is becoming more important as the healthcare industry increasingly focuses on providing the highest quality of care. Patients often visit doctors across specialties, especially when their disease involves multiple departments, such as in the case of oncology care. This makes it all the more important to develop one cohesive continuum of care not only for the patient and their providers, but also to ensure greater efficiency and long-term cost savings for payers.
“A multidisciplinary approach to cancer diagnosis and treatment is vital to optimize care for the cancer patient. Multidisciplinary cancer management requires coordination among many different specialties involved in cancer care of an individual patient. (This) is invaluable to the management of cancer patients and helps with immediate formulation of the recommendations for further management.”1 write the authors of Integration of Modern Imaging into the Multidisciplinary Setting: The Radiation Oncology Perspective.
This approach offers a variety of benefits as a result of improvements in communication between clinical disciplines and the nonclinical healthcare industry. This communication across the care continuum leads to more efficient decision making, which translates into improved outcomes for patients. Information sharing between providers is one of the major benefits of multidisciplinary care coordination and management. Providers who have experience in particular specialties can correspond with peers to share the latest literature, review cases, and discuss perspectives on improved clinical care.This multidisciplinary approach to cancer treatment is becoming more and more common on the clinical end, but is not being adopted as quickly by the nonclinical end of the healthcare industry. For instance, health plan special benefits management (SBM) companies continue to keep oncology imaging, radiation therapy, and medical oncology in separate siloes.
HealthHelp’s Integrative Oncology program creates a continual pathway for managing all cancer types. It unites multiple aspects of cancer care, allowing primary care, medical oncology, radiation oncology, radiology, biopsy/intervention specialists, and surgical specialties that may take part in a patient’s care, to integrate the care of oncology patients. This gives providers access to patient information about care that may have been administered by a provider in a different department or at an alternate facility, which helps to eliminate duplicate or unnecessary testing. HealthHelp does so by integrating the authorizations made across specialties for a patient, along with the clinical information collected during the authorizations into a medical record, then making that record available to providers via its Access product line. Coordination of care between specialties results in immediate reduction in unnecessary imaging and esting, many of which involve radiation exposure.
HealthHelp’s coordinated approach to oncology treatment has several goals, beginning with pre-cancerous stage risk determination and appropriate triaging. Timely and sequential screening related imaging reduces redundant imaging for a known or suspected mass, which thereby exposes patients to less radiation. Another goal is to identify the right regimen of care–including imaging, chemotherapy, radiation therapy and surgery–so patients are subjected to fewer and more focused interventions and treatments, depending on the stage and prognosis of their cancer.
HealthHelp has developed algorithms to determine risk level for patients, which serve as a basis to improve overall effectiveness of screening, imaging, and other diagnostic testing, care quality, patient safety, and outcomes, while reducing ineffective and unnecessary downstream testing due to false positives. The algorithms define appropriate risk levels so that the most appropriate screening test, follow-up imaging, and intervals between subsequent imaging and interventions can be defined, in essence, creating an individualized and personalized approach to applying diagnostic imaging guidelines. Depending on the outcome of diagnostic imaging and prognostic assessment at a personalized level, the therapy decisions for radiation therapy, medical oncology, and oncologic surgeries become much more specific to a patient’s care.
Oncology imaging focuses on screening and detection; staging; contouring; biopsy and treatment planning; pre- and post-therapy follow-up; assessment of treatment response; and surveillance of known cancer on an ongoing basis.
Radiation therapy requires the right modality and the right fractionation and is based on the tumor type, aggressiveness, and stage of the cancer involved. HealthHelp’s Radiation Therapy program of integrated care improves quality and safety by reducing four undesirable outcomes:
> Excessive radiation exposure, where the radiation dose per treatment is too high or total radiation dose exceeds the recommended dose, and could result in secondary cancers;
> Insufficient radiation dose, where the radiation dose per treatment is too low or the total radiation dose is less than recommended and fails to eradicate a tumor;
> Procedures with limited evidence to support improved survival;
> Significant complications.
HealthHelp reviews more than 10,000 radiation therapy requests annually, and 27 percent of HealthHelp’s physician-led, peer-to-peer assessments initially resulted in a change or withdrawal of radiation therapy requests. The peer-to-peer educative model has been embraced by physicians, and it sustains savings by changing long-term ordering patterns as ordering physicians increasingly adhere to best practices.
Medical oncology care may involve chemotherapy, biologics, hormone therapy, and supportive or prophylactic care. In the year after HealthHelp implemented its Medical Oncology program, the number of members treated increased by 19 percent, while overall spending declined by 18 percent. This illustrates the maximized efficiency of the HealthHelp model.
In addition to efficiency, there are a number of benefits to coordinating care across oncology-related specialties:
> It integrates cancer treatment pathways and protocols for imaging, chemotherapy, biologics, and/or supportive pharmacy, radiation therapy, biopsies, excisions, surgery, and transplants;
> It ensures patients receive proper screening, and prevents known mass-redundant imaging and false positive testing and interventions;
> It ensures a continuity of care for patients by triaging them to appropriate wellness programs, care and disease management programs, and care advocates;
> It ensures that provider and facility outliers follow corrective actions and are made transparent to members; and
> It follows quality measures and outcomes that are member-centric, not treatment-based.
Ultimately, HealthHelp’s integrated oncology care through cross-specialty collaboration benefits all concerned. Physicians, providers, and payer organizations enjoy greater efficiency and cost savings, while patients enjoy increased safety, lower costs, and higher-quality care.
1 Integration of Modern Imaging Into the Multidisciplinary Setting: The Radiation Oncology Perspective, by Steven Feigenberg, MD, Christina Campassi, MD, Navesh Sharma, DO, PhD, Susan B. Kesmodel, MD, Katherine Tkaczuk, MD, University of Maryland School of Medicine, Baltimore, MD, and Jian Q. Yu, MD, FRCPC, Fox Chase Cancer Center, Philadelphia, PA; Applied Radiology; www.appliedradiology.com/articles/integration-of-modern-imaging-into-the-multidisciplinary-setting-the-radiation-oncology-perspective#sthash.3XvwymCT.dpuf