The idea behind accountable care is that a diverse team of physicians of different disciplines would combine with other top clinicians including care navigators, social workers and nurses to provide the patient with the best evidence-based care, ready access to information and a team working together.
If ever there were a discipline where the accountable care structure was already being tested, it would be in cancer care, says Ian Buchanan, MD, MPH, Associate Vice President, Oncology and Urology UNC Health Care System in Chapel Hill, N.C., and one of the featured speakers at HealthLeaders Media Rounds "A Programmatic Approach to Cancer Care" simulcast from noon-3 p.m. Eastern time on Friday, Dec. 16, live from Banner MD Anderson Cancer Center in Phoenix, AZ.
Host speakers from Banner MD Anderson Cancer Center include Edgardo Rivera, MD, Medical Director, Vicki Koceja, RN, PhD, clinical administrative director and Michael Bianchi, associate administrator.
Cancer care can seem fractured, often with multiple providers in different specialists and working for different groups trying to coordinate care. And the nature of the disease itself plays a role, he says.
"The nature of care is different. You have a lot of acuity and a lot of need for a protracted period of time," Buchanan says. "There are few other diseases that require so many professionals to be engaged," he says, with the closest comparison being solid organ transplant.
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.
Jim Molpus is the director of the HealthLeaders Exchange.