Delivering High-Quality Cancer Care Charting a New Course for a System in Crisis (2013) / Chapter Skim
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The growing demand for cancer care, combined with the complexity of the disease and its treatment, a shrinking workforce, and rising costs, constitute a crisis in cancer care delivery (see Box S-1)
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liative care consultants) or does not identify palliative care management as an important component of high-quality cancer care.
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Age is one of the strongest risk factors for cancer, and there are many important considerations to understanding the prognoses of older adults with cancer and formulating their care plans, such as altered physiology, functional and cognitive impairment, multiple coexisting morbidities, increased side effects of treatment, distinct goals of care, and the increased need for social support. The current health care delivery system is poorly prepared to address these concerns comprehensively.
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The green arrow identifies three overlapping phases of cancer care, which is a way of conceptualizing the period of the cancer care continuum that is the focus of this report. Figures S-1 and 1-1 R02518 landscape
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6. Accessible, affordable cancer care: A system that is accessible to all patients and uses new payment models to align reimbursement to reward care teams for providing patient-centered, high-quality care and eliminating wasteful interventions (see Chapter 8)
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. The committee recognizes the importance of access and affordability in a high-quality cancer care delivery system but expects the Patient Protection and Affordable Care Act (ACA)
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7. Develop a learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings.
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Recommendation 1: Engaged Patients Goal: The cancer care team should provide patients and their fami lies with understandable information on cancer prognosis, treat ment benefits and harms, palliative care, psychosocial support, and estimates of the total and out-of-pocket costs of cancer care. To accomplish this: • he National Cancer Institute, the Centers for Medicare & Med T icaid Services, the Patient-Centered Outcomes Research Insti tute, as well as patient advocacy organizations, professional organizations, and other public and private stakeholders should improve the development of this information and decision aids and make them available through print, electronic, and social media.
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• he cancer care team should revisit and implement their pa T tients' advance care plans. • he cancer care team should place a primary emphasis on pro T viding cancer patients with palliative care, psychosocial sup port, and timely referral to hospice care for end-of-life care.
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The workforce must also have the distinct set of skills necessary to implement the committee's conceptual framework for a high-quality cancer care delivery system. The recent IOM report Retooling for an Aging America: Building the Health Care Workforce recommended enhancing the geriatric competency of the general health care workforce.
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To accomplish this: • rofessional organizations that represent clinicians who care P for patients with cancer should define cancer core competencies for their memberships. • ancer care delivery organizations should require that the C members of the cancer care team have the necessary compe tencies to deliver high-quality cancer care, as demonstrated through training, certification, or credentials.
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Given that the majority of cancer patients are over 65 years and have comorbid conditions complicated by other health (e.g., physical and cognitive deficits) and social (e.g., limited or absent social support, low health literacy)
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Many of the elements needed to create a learning health care system are already in place for cancer, including electronic health records, cancer registries, a robust infrastructure for cancer clinical trials, and biorepositories that are linked with clinical data. Unfortunately, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning health care system.
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• he Centers for Medicare & Medicaid Services and other pay T ers should create incentives for clinicians to participate in this learning health care system for cancer, as it develops. Translating Evidence into Practice, Measuring Quality, and Improving Performance A high-quality cancer care delivery system should translate evidence into clinical practice, measure quality, and improve the performance of clinicians.
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has also attempted to influence quality measurement for cancer care through various mandatory reporting programs. Recommendation 8: Quality Measurement Goal: Develop a national quality reporting program for cancer care as part of a learning health care system.
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illustrates the concept of using quality measurement and new payment models to reward the cancer care team for providing patient-centered, high-quality care and eliminating wasteful interventions. The current fee-for-service reimbursement system encourages a high volume of care, but it fails to reward the provision of high-quality care.
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• he Centers for Medicare & Medicaid Services and other pay T ers should develop payment policies that reflect the evidence based findings of the professional societies. • he Centers for Medicare & Medicaid Services and other payers T should design and evaluate new payment models that incentiv ize the cancer care team to provide care that is based on the best available evidence and aligns with their patients' needs, values, and preferences.
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18 DELIVERING HIGH-QUALITY CANCER CARE HHS, other federal agencies, and industry, must reevaluate their current roles and responsibilities in cancer care and work together to develop a high-quality cancer care delivery system, starting with improving patientclinician interactions. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer a diagnosis.
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