At the same time, "that level of coordination runs afoul of some of the traditional models of medical care." Many hospitals, he says, still may not operate as true service lines and have department or other structures that may not optimize team-based healthcare. Those divisions are complicated by a reimbursement system—including Stark guidelines—that make it difficult to reward independent physicians to participate in coordinated care activities.
Still, patients are increasingly expecting that their cancer care will be coordinated by a unified entity, and public and private payers expect that same coordination to reap benefits in reduced waste and more value.
"More so in cancer than in most other services, there is an overlap between what patients expect and payers want," Buchanan says. "In that sense, cancer care can be the prototype for an accountable care organization."
UNC has deployed nurse navigators who guide patients through their care options and help them navigate care episodes that can last several months or longer, he says. The UNC system also works closely with cancer specialists throughout the state with an inexpensive network of telemedicine tools that keep community physicians engaged in care of patients.
More patients are recognizing the need to go to a major cancer center for their care, though "not necessarily an academic one," Buchanan says, to get the higher level of coordination they need.