A New Paradigm of Value-Based Cancer Care:The NCCCP

Mark J. Krasna, MD

December 2011, Vol 2, No 7 - Cancer Care


The goals set by the National Cancer Institute (NCI) to establish the NCI Community Cancer Centers Program (NCCCP) are in – tended to1:

  • Enhance access to cancer diagnosis and care with a focus on healthcare disparities
  • Improve quality across the care continuum using evidence-based medicine and a multidisciplinary team
  • Use electronic health records to enhance communication between all providers (initially with implementation of the cancer Biomedical Informatics Grid)
  • Expand research by increasing the number of clinical trials offered, in – cluding early-phase studies; enhance survivorship programs • Introduce biospecimen collection best practices in the community
  • Establish connections with national research efforts.

This collaboration affords the NCI the opportunity to access large community hospitals with disparate populations; learn how to coordinate care in communities; provide optimal screening, follow-up, and support systems; and ensure comprehensive, evidencebased cancer care.

Defining Optimal Cancer Care
Many clinical trials today can be offered in community settings. The NCCCP community cancer centers would evaluate how best to provide the NCI with research opportunities in a community setting and to investigate the value of public/private partnerships between the NCI, hospitals, and physician groups involved in this care. In addition, this effort is essential in furthering research, dissemination, and advances in our pillar areas.

One of the quality-of-care pillar goals is to increase multidisciplinary, site-specific cancer care conferences and clinics—multidisciplinary centers (MDCs); increased use of evidencebased guidelines is encouraged. Sites are expected to participate in NCCCP quality improvement projects and expand genetic and molecular-testing programs. Another novel approach is to establish and adopt cancer center– specific physician conditions of participation, which would impact all other pillars. These conditions would help define the relationship and accountabilities between the physicians and the cancer center.2-4

The nurse coordinator/navigator is pivotal to the success of anyMDC program. 5 The navigator triages new patients to appropriate team members and is responsible for the organization, prioritization, and scheduling/coordination of care. They manage patient flow in the clinic and act as an interface between the team and the patient. In addition to providing follow-up, triage, communications, education, support, and continuity of care, they can facilitate clinical trial eligibility. They are, as many patients call them, the “go-to” people.

Uncoordinated versus Coordinated Care
MDC team members include physicians, midlevel providers, nurses, dietitians, social workers, genetic counselors, financial counselors, spiritual care providers, smoking-cessation counselors, research and registry staff, and administrative coordinators.

How can we integrate physicians into multidisciplinary cancer care? There is obvious value to patients and physicians, but, as always, physicians have time constraints. The navigator/ coordinator can help to facilitate cancer care for which the physicians may not have time. Although it requires more time and coordination of scheduling, multidisciplinary care clinics are especially helpful for today’s patient with cancer who receives multimodality therapy.

Introducing this concept into the physician practice must be done gently and respectfully, which is achieved by creating a culture of partnership. One way of ensuring this relationship is to offer fair market value for time spent in cancer care, especially in clinics. The use of the work relative value unit or equivalent to measure productivity can help measure the success of physicians in the program and even allow for incentives.

Ultimately, the goal of effective patient flow is to make the right information available to the doctor and the patient at the right time. This allows for seamless care, minimal patient waiting time, minimal physician waiting time, and enhanced patient and staff satisfaction.

The Benefits of Multidisciplinary Care
Although it is inherently apparent that MDC care provides better cancer care, there is a need for more data. We need to demonstrate improved patient satisfaction, use multidisciplinary care clinics in addition to conferences, develop and distribute treatment summaries, and show improved processes. Over time, we should demonstrate increased referrals to physicians who participate; identify data for outcomes measurement, such as shorter time to diagnosis and treatment, length of hospital stay, and better survival rates: overall improved patient care.

Several obvious, and less obvious, benefits to the system or to the cancer center are associated with instituting MDC care. Improving quality and packaging MDC care may result in lower costs; oncology reputation spins off other business for institutions. Improvements could also increase physician alignment and engagement, facilitate clinical trials accrual to generate revenue, and improve efficiency.6 Cancer center administrators must prove the return on investment of comprehensive services for their senior leadership to “buy in” to MDCs.

How can we ensure the success of MDCs? The physician program leaders and members must realize that they do not have all the answers to all the questions or resources. Recognizing the value in involving other team members in the care of these patients and remaining open-minded to others’ ideas are necessary. These leaders must also be willing to accept criticism and embrace other specialties. Learning the medical, radiologic, pathologic, surgical, and radiation oncology literature makes team leaders more reasonable “shepherds” for the team. Supporting a team approach will ultimately lead to patient-centered, compassionate care.5,7

NCCCP Sites’ Deliverables Metrics
Each of the 30 NCCCP sites has deliverables with metrics for each core component, which are established by the NCI and monitored through SAICFrederick subcontracts. Progress is tracked through detailed annual assessment surveys reported quarterly to SAIC-Frederick.

The NCCCP is a unique program that integrates activities by eliminating disparities, improving quality of care and information technology across the cancer continuum, linking with many other NCI programs, incorporating how knowledge gained from NCI programs can be translated into a community setting, developing a strong hospital- based community cancer center network to support NCI goals, and supporting the research infrastructure.

The NCCCP: A Look into the Future
Thus far, the NCCCP has demonstrated that community cancer centers and systems can deliver MDC care, participate in clinical trials, and begin to bridge disparities in cancer care. It has shown that the public–private partnership works with a strategic vision to the future of cancer care. The challenges for year 5 are to complete outcomes studies, codify what works, continue dissemination of best practices and results, collaborate with NCIdesignated cancer centers on a large number of these issues, and consider what additional studies might further our initial efforts.

Acknowledgment This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E.

References

  1. NCI Community Cancer Centers Program. Communi – ty access to the latest science. http://ncccp.cancer.gov. Accessed November 17, 2011.
  2. Krasna M, Petrelli N, Salner A. Multidisciplinary cancer care: a new model for community cancer centers. Part I. J Multidiscipl Cancer Care. 2009;1:1,12-13.
  3. Krasna M, Petrelli N, Salner A. Roundtable on multidisciplinary care: the NCCCP. Part II. J Multidiscipl Cancer Care. 2009;2:23,29.
  4. Zaren HA. Conditions of participation: developing effective partnerships. Oncol Issues. January/February 2011:29-32.
  5. Swanson PL, Strusowski P, Asfeldt T, et al. Expand – ing multidisciplinary care in community cancer centers. Oncol Issues. January/February 2011:33-37.
  6. Krasna MJ. Multidisciplinary cancer clinics: a vision for optimal cancer care. Oncol Business Rev. January 2009:12-13.
  7. Petrelli NJ. A community cancer center program: getting to the next level. J Am Coll Surg. 2010;210:261-270.