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Why Care Coordination Is Crucial to Oncology

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Cancer is a complicated disease that takes a significant toll on patients’ physical and psychological well-being, which is why effective treatment encompasses the whole person—body, spirit and mind. Consequently, comprehensive care coordination services are fundamental to any oncology practice.

Care coordination allows the care team to focus on both the mental and physical health of its patients. For example, a nurse on the team may act as a liaison for patients throughout their cancer journey, advising on side effects and symptom management, answering questions, addressing concerns, coordinating community resources and lending an empathetic ear to help support the patient’s emotional needs—and those of caregivers.

A Team Effort

Cancer patients are going through a tumultuous and scary time, which frequently gives rise to questions about treatments and possible side effects. They want questions answered quickly but are often reluctant to call their physician. Frustrations can become exacerbated when patients who do call are forced to leave a message and wait for a return call.

Under care coordination models, patients are assigned to an RN care manager and have access to a nurse 24 hours a day, seven days a week who provides timely answers and advice, calms fears and assuages concerns. These relationships are built on trust and become an important catalyst for preventing unnecessary costs associated with inappropriate trips to the emergency room.

Robust care coordination programs also include dietitians on the patient’s team. Studies have shown that patients who maintain a stable diet while undergoing treatment are more likely to complete the course, which can be lifesaving. Dietitians are able to tailor nutritional plans for patients who, for example, have difficulty swallowing as a result of treatments for head or neck cancer or for pancreatic cancer patients who cannot digest food normally. Patients experiencing weight gain due to treatments can also lean on dietitians for help.

Care Coordination During COVID-19

As coronavirus cases continue to surge across the country, many cancer patients are understandably hesitant to leave the house—especially since they are at a high risk for the most severe aspects of the virus.

At AON, our care coordination team is addressing these very real concerns through telehealth, allowing our dietitians to continue meeting with patients without requiring them to leave their homes. The transition from face-to-face to virtual has gone very well. In fact, more patients are making appointments with dietitians now than they were before the pandemic hit.

The benefit of using telehealth to reach our patients is two-fold. It allows patients to meet with members of their care coordination team from the safety of their own home, and it keeps them connected to people they trust and can rely on during an incredibly stressful and fearful time. The COVID-19 pandemic has been exceptionally difficult for cancer patients, so it is important for them to know that their care is here for them even if we can’t meet physically.

How A Network Can Help

A lot of work is involved in the implementation of a care coordination program and some independent practices may not have the manpower or bandwidth to accomplish it properly.

For practices that partner with AON, a care coordination program is already established for patients who qualify for the Oncology Care Model. Our network’s care management department also offers a variety of support activities, such as refilling medications, meet-and-greet phone calls to new patients to gather information for their clinical team, and managing paperwork. The result is an unprecedented level of care that doesn’t require a practice to add staff or increase costs. With AON alleviating much of the administrative burden, it also allows the practice to focus on its top priority: the patients.

AON also offers an app-based support portal for nurses and dietitians that helps them quickly locate providers of almost any resource they need in their surrounding community. We are currently working on building one that will give patients access to AON’s robust database of resources and community-based services such as housing and assisted living, nutrition, food support, respite care, financial assistance and transportation services.

Treating cancer involves treating the whole patient. A care coordination program enhances a practice’s ability to do so.

Addressing Oncology Care Continuity During a Public Health Crisis

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Crisis situations often call for creative solutions in healthcare and lean on the true strength of provider-patient relationships. While the stress of the COVID-19 pandemic is experienced across all walks of life, those with chronic or life-altering illnesses face unique challenges.

Care delivery for these patients cannot be put on hold. When dealing with a health crisis of such monumental proportions, oncology practices must identify ways of keeping patients safe and on track to achieve optimal outcomes. For cancer patients, the best approach ensures the full spectrum of care is addressed, including treatment, nutritional and emotional support.

Rolling with the Changes

Amid stay-at-home and social distancing orders, oncology practices remain essential and cannot simply shut their doors. Instead, providers need to adapt the way they run their practice while still maintaining continuity of care.

Our providers at American Oncology Network (AON) have deferred non-critical visits, such as six-month and annual follow-ups, but are continuing to see patients who are undergoing treatment or are newly diagnosed. In addition, we check with patients prior to each visit to determine if they are experiencing any symptoms associated with the virus – such as fever, cough, shortness of breath – and require they wear a mask to their appointment. One AON practice in Columbus, Ohio, screens patients for symptoms in a tent outside their facility before allowing them inside. All staff members have their temperatures taken daily, before and after each shift, and non-essential visitors are required to wait outside the clinic.

Amid industry shortages, our procurement team has done a tremendous job of ensuring our practices have the supplies they need to keep their facilities clean to ensure the safety of our patients – even going “old school” to overcome the lack of pre-packaged disinfectant wipes by utilizing paper towels and  FDA approved cleaning solvents.

The Rise of Telehealth

Telehealth, which allows patients and physicians to communicate through videoconferencing, is experiencing a significant surge in utilization – not only because the COVID-19 pandemic has made it a necessity to conduct patient appointments remotely, but also because the Centers for Medicare and Medicaid Services has relaxed reimbursement requirements, with many commercial plans following suit. Telehealth is expected to remain popular even after the pandemic is gone.

Our physicians understand the benefits of developing personal relationships with each of their patients, which typically begin with a face-to-face visit. Over time, however, as the bond between doctor and patient grows stronger, telehealth may become a very viable alternative where appropriate. This current health crisis has simply accelerated its acceptance and adoption. And while there are some long-term issues to figure out, the COVID-19 pandemic has taught us that telehealth is essential to maintaining patient access to high-quality care.

Unfortunately, as could be expected, many small, independent community practices lack the IT expertise, bandwidth or technology to implement telehealth quickly enough to effectively serve their patients. Thankfully, because of the existing infrastructure and technical expertise at AON our growing network of more than 130 providers was able to offer virtual appointments via telehealth to their patients within a span of four days and all locations are conducting these types of appointments daily.

Compassionate and Patient-centric

While telehealth has become an essential part of practicing medicine, our practices haven’t lost sight of the emotional needs and mental health of our patients. AON addresses this through triage nurses and social workers proactively reaching out to patients suffering from depression or struggling with the isolation that comes with the current social distancing measures.

I cannot stress enough, especially under these circumstances, the importance of why we are in this business – to provide our patients with the best care possible.

Our patients are at the center of everything we do and every decision we make. Now, they need us more than ever. We are taking every possible step to continue providing exceptional care, safely and compassionately.

Drivers and Key Criteria for Successful Telehealth Programs

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The onset of the COVID-19 pandemic has brought telehealth and telemedicine to the forefront of the American healthcare industry. Through laptops, tablets and a host of other devices, telehealth allows physicians to examine and diagnose their patients remotely to comply with current social distancing guidelines and combat the spread of this highly contagious and deadly virus.

Even before COVID-19 made its way to the United States, the American Oncology Network (AON) was advancing use of telehealth as an effective element of its care management services, using video conferencing to connect patients with nutritionists. This has proved beneficial for our practices who now need to ramp up telehealth systems quickly in response to the pandemic to ensure continuity of care and optimal safety for their patients.  

Strong systems that are easy to use and can adapt quickly to change are crucial to the design of successful telehealth programs, especially at a time when demand is at an all-time high.

Ramping Up Quickly

Implementing an effective telehealth system is a complex, resource-intensive undertaking. It’s a cross-functional effort requiring clinical, operational and technical teams to work together to prepare technologies, workflows and staffing models. Proper codes must be added, financial teams brought up to speed and staff trained on electronic medical records (EMR) and telehealth platforms. It can take weeks or months – and prove quite costly – for the average private practice. In addition, small, independent practices rarely employ full-time IT or security staff, necessitating help from outside professionals who are not likely to be familiar with oncology. This not only increases costs, but also lengthens implementation time.

However, AON providers were able to rapidly start treating their patients, drawing on our team’s expertise and scalable system designs. As demand for telehealth skyrocketed, we quickly identified an appropriate vendor, wrapped up the paperwork and helped our practices onboard the new system in less than 20 hours. After four days of training, our provider groups were seeing patients. So far, they have amassed 2,717 virtual visits – and counting.

In addition, practice administrators and providers have peace of mind knowing that our security experts are aligning systems with the latest best practices and can address potential issues in hours rather than days.

Keeping it Simple

When it came to choosing a telehealth solution, AON wanted a partner that was flexible, scalable and could adapt very quickly to change. Most importantly, we wanted to keep the system simple for physicians and their patients.

On the physician side, it was important that the solution offer streamlined navigation so providers could fire up their device and be on time for scheduled appointments. For patients, we wanted to minimize effort and resource requirements. As such, any device – laptop, cellphone, tablet, etc. – equipped with a camera and microphone allows them to log on and speak with their physician. Our systems do not require installation of any additional programs or apps – we simply send patients a link that runs natively in a browser, making telehealth easy and accessible for everyone to use, no matter how savvy they are when it comes to technology.

Customers Come First

The strength of AON isn’t just our systems, but the customer-first approach that drives our IT department. That’s why we were able to shift gears so quickly to handle the swift changes brought about by COVID-19, and why we were able to train more than 130 physicians and mid-level providers in one weekend, rather than our normal load of about 10 providers over the course of a week. Nursing professionals and social workers have since been added to training, expanding the spectrum of possible telehealth services.

We have providers of all different stripes when it comes to technology proficiency – and it doesn’t matter. AON is here to equip our practices with whatever they need, whether that means installing cameras or enabling secure online meetings.

While telehealth has its limits – physicians can’t physically examine their patients – the COVID-19 pandemic has underscored its effectiveness at supporting certain care processes. However, to be successful, a telehealth system must be implemented with patients and providers at the forefront, and it needs to be able to adapt to change. In preparation for expected surges in patients and the future of healthcare, oncology practices are wise to consider a strong partner to help guide the telehealth process.