Managing the complexity of outpatient oncology care


Chadi Nabhan, MD, MBA, FACP

Chief Medical Officer, Cardinal Health Specialty Solutions

Approximately 1.8 million new cancer cases are detected annually, and the majority of cancer patients remain alive five years after diagnosis, underscoring the need for proper coordination of care.  However, the process of coordinating oncology care has become more complicated due to changing healthcare market dynamics, including the transition away from fee-for-service payment to value-based reimbursement.  As growing numbers of cancer patients are now seen in the outpatient setting, enhancing ambulatory operations to better meet their needs is an essential strategic initiative for all cancer centers. 

The complexity of coordinating care stems from many new variables in the oncology care market. With increased insurance availability due to the Affordable Care Act (ACA), more patients are entering the healthcare system – and institutions that are already overwhelmed may be further stretched. This poses particular challenges in cancer care where patients demand timely visits following a diagnosis. The emphasis of the ACA on coordinating seamless care for patients underscores the need for ambulatory operations to focus on access, synchronization and patient satisfaction. This is more critical in the current era where interdisciplinary care (surgery, medical oncology, radiation, and supportive care services) is essential for driving the best patient outcomes. Meeting all of these needs is an increasing challenge as the number of U.S. oncologists remains constant despite a growing demand for their services.

A universal solution to these complexities is not practical, but a there are few key strategies that may help in the years ahead.

  • Investing in comprehensive survivorship programs would help transition cured patients to non-oncology providers, which would free up medical oncologists to spend more time with newly diagnosed patients.
  • Incorporating nurse navigation programs that are disease-specific could help in better care coordination and would likely will lead to improved patient satisfaction.
  • Recognizing the need for timely appointment visits for discharged patients suggests that planning ahead and having allocated slots for these patients, depending on projected volumes, can help in assuring timely visits.
  • Creating a pharmacists-led clinic to assure adherence and medication reconciliation is critical given increased use of oral anti-neoplastics and their potential interactions with other therapies. This can be ideally achieved within a comprehensive and well-organized supportive care and integrative oncology programs.

As changes in the economy, technology and regulations exert increased pressure on ambulatory oncology centers, more attention to strategies to enhance their operations will be greatly needed.

Editor’s Note: Read Dr. Nabhan’s full article, “Ambulatory Oncology Operations: Strategies to Alleviate Complexity” from the Journal of the National Comprehensive Cancer Network, October 2016.