In 2016 the Association of Community Cancer Centers (ACCC) launched a three-year initiative to develop an optimal care coordination model (OCCM) to serve lung cancer patients on Medicaid. Funding and support for this project is provided by a grant from the Bristol-Myers Squibb Foundation (BMSF). Phase I of the project began with an environmental scan providing the foundation for the project, identifying the ongoing issues this vulnerable patient population faces. It is critical to focus on improving access and quality of lung cancer services to the Medicaid population given the risks of smoking (the CDC reports that American adults who are uninsured or on Medicaid smoke at rates more than double those of adults with private health insurance or Medicare).
Building the Model
To lay the foundation for development of an optimal care coordination model (OCCM) for lung cancer patients on Medicaid, ACCC completed an environmental scan. The scan included a literature review as well as insights from the project’s Advisory Committee members, a lung cancer survivor and patient advocate, and staff from two ACCC-member cancer programs, which were gathered in a series of interviews conducted in April and May 2016.
Next, through a competitive application process, ACCC recruited Cancer Program Members to serve as project Development Sites — providing real-life experiences illustrating successes and challenges to delivering cancer care to these patients. Each site was visited over a two-day period between August-October 2016, during which ACCC met with a multitude of physicians, staff, patients, and referring providers to obtain their unique perspectives on care delivery across the continuum from initial access through end of life. Read the Development Site reports for snapshots of successes and challenges in providing care to lung cancer patients on Medicaid.
Building on the information gleaned during the research phase, the project’s expert Advisory Committee convened for an in-person meeting in November 2016, for a robust discussion of the project findings and to further inform the development of the OCCM. The model developed for this project builds directly upon the Multidisciplinary Care (MDC) Assessment Tool created by the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP), a project funded by NCI from 2007-2014. The OCCM is designed to be used for the benefit of cancer programs of all resource levels to improve lung cancer care for patients with Medicaid.
To help guide the Advisory Committee in the development of the OCCM, a Technical Expert Panel was formed, composed of individuals who participated in the NCCCP initiative. The OCCM is not meant to evaluate every aspect of care for a patient with lung cancer, but focuses on 13 areas with high impact on optimal care. Care coordination is assessed from the time of initial patient referral to the cancer program through survivorship and end of life. Each assessment area of the OCCM has 5 levels, with level 1 representing the most basic provision of care and level 5 representing optimal best practice.
Testing the Model
In 2017 the project entered Phase II. ACCC recruited seven Cancer Program Members* to serve as Testing Sites for the beta Optimal Care Coordination Model. Testing is necessary to ensure that the Model is a practical, easy-to-use guide to help cancer programs improve care for their patients. As part of the Testing Site application process, programs used the beta Model for program self-assessment, and then developed quality improvement project(s) within the context of the 13 OCCM assessment areas.
During Phase III the Testing Sites will deploy the beta Model to conduct one or more quality improvement projects over a 12-month period, from October 2017-September 2018. Results from the testing phase will be used to further refine and modify the Model.
*Under the terms of the grant, programs in the following states are excluded from participation in this project: AL, GA, KY, MS, NC, TN, SC, and WV.