By integrating palliative care into oncology, people facing serious illness such as cancer can gain access to quality care delivered by an interdisciplinary team that addresses their needs and those of their caregivers holistically over time. Recognizing this need, C-TAC, TFA Analytics, and The Sheri and Les Biller Family Foundation have embarked on a project based on three critical ways to increase access to care:
- Integrate evidence-based principles of high-quality specialty care for people with serious illness into specialty oncology and care for all cancer types.
- Expand access to care models that support interdisciplinary care for people with serious illness through value-based reimbursement.
- Collaboration with private payers (health plans, employer groups, and other purchasers) to ensure access to payment, assessment, and delivery of care.
In order to achieve these objectives, the project aims to: 1) recommend eligibility criteria for cancer patients’ referral to palliative and supportive care, 2) develop a standardized palliative and supportive care referral pathway for eligible cancer patients, 3) develop and implement pilot programs to test the integrated palliative care and oncology care model, 4) produce educational materials for engagement in available services including outreach materials, and 5) contribute to building the body of evidence of the benefits of integrating palliative and supportive care into oncology services for people with cancer.
In the initial project stages, a systematic literature review of clinical trials and international guidelines for integration of palliative and supportive care and cancer will be performed. In addition, a clinical advisory council will be formed and be composed of 10-12 clinicians with oncology and supportive care backgrounds who are representative of geography, setting (academic center/community practice), race/ethnicity, research/practice/education, and cancer experience. TFA and the Biller Family Foundation will work to engage the American Society of Clinical Oncologists, Community Oncology Alliance, AAHPM, and CAPC to identify and select advisory council members. The advisory council will guide the project and provide input on outcomes measures, pilot methodology, and clinical referral criteria. The referral criteria developed will be evidence-based and used to identify eligible patients for the pilot programs.
Regarding the pilots, their aim is to increase access to palliative and supportive care to cancer patients and their caregivers by implementing clinical programs based on this care model. The pilots will also help to align clinical and administrative standards and expand the evidence of delivering interdisciplinary palliative and supportive care delivered to people with cancer. Participating sites will be health plans, health systems, and serious illness coalitions across 4 states – Utah, North Carolina, New Jersey, and Ohio. Sites will include cancer centers serving multiple populations and ages, with two regions implementing standardized payment models for palliative or supportive care for commercially insured and/or Medicaid recipients. The regions were selected for representativeness in geography and geopolitical affiliations, which in turn will help demonstrate the universality of the intervention’s effectiveness.
To support the delivery of palliative services at these sites, a standard value-based payment model for palliative care will be used for cancer patients covered by participating payers. For instance, introducing a bundled payment rate, or a pre-determined amount of money paid to a provider organization to cover the average costs of all services needed to achieve a successful outcome for a pre-defined episode of care, can allow for financial incentives to provide coordinated palliative care that accounts for the higher risk associated with people who are seriously ill.
To ensure that the project is achieving its intended outcomes, a methodology to evaluate the impact of project activities on these desired outcomes will be developed. This will include a quality measurement framework based on evidence-based standards such as Choosing Wisely, American College of Oncology, Enhancing Oncology Model, Oncology Medical Home, and Value in Cancer Care Initiative Standards. Outcomes measures will also be selected focused on clinical quality of care, quality of life, patient-reported outcomes measures, health services utilization, and total cost of care.
Lastly, access to and utilization of palliative and supportive care sometimes suffers due to lack of awareness, provider training, or unclear referral criteria that can be used to ensure improved coordination of care. This can occur even when participating in value-based arrangements or strategies with community partners to expand the reach of activities to support palliative care. As such, the project will aim to develop educational materials and training for clinical oncology staff to assess, refer, and coordinate with supportive care teams and palliative care specialists to ensure services can be delivered. Educational and outreach materials will be created for patients and families to ensure understanding of and access to available palliative and supportive care.
Patients with cancer have many treatment needs, as well as needs that are not strictly medical, such as financial, spiritual, emotional, and social needs. Through this project, C-TAC, TFA, and The Sheri and Les Biller Family Foundation hope to demonstrate that by integrating palliative care into oncology these needs can be met and improve the lives of patients living with cancer.
About Palliative Care
Palliative care is defined by the Centers for Medicare and Medicaid Services (CMS) (see page 7) as “patient and family- centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.” Moreover, palliative care should be delivered by an appropriately trained and prepared interdisciplinary team, the members of which have demonstrated competency in palliative care. When palliative care is incorporated into serious illness care, it has been demonstrated to improve outcomes and quality of life for patients, especially those with serious illness who are currently experiencing symptoms related to their health condition. This is no different when it comes to cancer care.
