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Optimal Care Coordination


In 2016 the Association of Community Cancer Centers (ACCC) launched a three-year initiative to develop an optimal care coordination model (OCCM) to serve lung cancer patients on Medicaid. Phase I of the project began with an environmental scan providing the foundation for the project, identifying the ongoing issues this vulnerable patient population faces. Through a competitive application process ACCC recruited Cancer Program Members to serve as project Development Sites, providing real-life experiences illustrating successes and challenges to delivering cancer care to these patients. Each site was visited over a two-day period between August-October 2016, during which ACCC met with a multitude of physicians, staff, patients, and referring providers to obtain their unique perspectives on care delivery across the continuum from initial access through end of life. This research phase of the project yielded comprehensive reports from each of the five Development Sites.

Building on the information gleaned during the research phase, the project’s expert Advisory Committee convened for an in-person meeting in November 2016, for a robust discussion of the project findings and to further inform the development of the OCCM. The model being developed for this project builds directly upon the Multidisciplinary Care (MDC) Assessment Tool created by the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP), a project funded by NCI from 2007-2014. The OCCM is being designed to be used for the benefit of cancer centers of all resource levels to improve lung cancer care for patients with Medicaid.

To help guide the Advisory Committee in the development of the OCCM, a Technical Expert Panel was formed, composed of individuals who participated in the NCCCP initiative. The OCCM is not meant to evaluate every aspect of care for a patient with lung cancer, but focuses on 13 areas with high impact on optimal care. Care coordination is assessed from the time of initial patient referral to the cancer program through survivorship and end of life. Each assessment area of the OCCM has 5 levels, with level 1 representing the most basic provision of care and level 5 representing optimal best practice.

In 2017 the project is entering Phase II, where ACCC will again recruit Cancer Program Members to submit applications to serve as Testing Sites for the OCCM. Testing is necessary to ensure that the OCCM is a practical, easy-to-use guide to help cancer programs improve care for their patients. ACCC will release a comprehensive request for applications (RFA) at the end of February. The RFA will require Testing Site applicants to submit quality improvement (QI) projects detailing how they could improve care at their cancer program after conducting an internal analysis of the 13 OCCM assessment areas.

Phase III, which will consist of testing the OCCM, will take place over a 12-month period, from October 2017-September 2018.

Environmental Scan

Environmental Scan-Optimal Care Coordinatin Model for Lung Cancer Patients on MedicaidTo lay the foundation for this project, ACCC completed an environmental scan with a focus on efforts to coordinate care after lung cancer diagnosis to improve experiences and outcomes for Medicaid beneficiaries. The scan included a literature review as well as the insights from the project’s Advisory Committee members, a lung cancer survivor and patient advocate, and staff from two ACCC-member cancer programs, which were gathered in a series of interviews conducted in April and May 2016. During Phase I of the Optimal Care Coordination for Lung Cancer Patients on Medicaid initiative, the scan report helped guide work with the project’s five Development Sites.

Read the full environmental scan here.

Read key findings from the scan here.

Access the literature review bibliography here.

Development Sites

Five ACCC Cancer Program Members were selected to serve as Development Sites for the first phase of the Optimal Care Coordination for Lung Cancer Patients on Medicaid project. Working with these sites, ACCC documented the current state of care coordination for Medicaid patients with lung cancer and formulated draft principles to guide the development of the optimal care coordination model for this patient population.

From August through October 2016, the Development Sites hosted site visits during which ACCC staff interviewed key cancer center team members, Medicaid patients, and referring providers to better understand current care coordination processes and effective practices. In project Phase II and III, the care coordination model is being developed and its efficacy tested at separate Testing Sites.

The Optimal Care Coordination Development Sites are:

  • Florida Hospital Cancer Institute, Memorial Medical Center, Daytona Beach, Florida
  • Genesis Cancer Care Center, Genesis Health Care System, Zanesville, Ohio
  • Harold Alfond Center for Cancer Care, MaineGeneral Medical Center, Augusta, Maine
  • Mary Bird Perkins  – Our Lady of the Lake Cancer Center, Baton Rouge, Louisiana
  • Sidney Kimmel Cancer Center, Methodist Hospital Division, Philadelphia, Pennsylvania

A summary of the key findings from the site visit interviews will be shared in early 2017. The Development Sites will continue to participate for the length of this three-year project.

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