By Jennifer Jang, ASTRO Communications
Two Chicago-area organizations, Cancer Support Center and LivingWell Cancer Resource Center, were selected as ASTRO’s 2021 Survivor Circle grant winners for the services they provide to cancer patients, their families and caregivers. Each organization received a $10,000 grant in late 2021 and were honored at the 63rd Annual Meeting in Chicago. Specifically, the Survivor Circle Grant Program provides financial gifts to two cancer support organizations in the state hosting ASTRO’s Annual Meeting. ASTRO followed up with both organizations to learn more about how the grants provided tangible aid in the past year.
The Cancer Support Center (CSC), located in Chicago, is a community-based non-profit organization with two facilities in Chicago’s Southland neighborhoods of Homewood and Mokena. CSC serves anyone seeking oncology care and focuses on a health equity initiative providing services to communities of color with high cancer morbidity rates. CSC uses the Five Point Model of Cancer Care, which comprises Counseling/Stress Management, Education, Nutrition, Fitness and Body Image. “Navigators,” as they call their providers, address these points at the first meeting, when the first time “participants,” as they call their clients, come in the door.
Pre-COVID-19, when a cancer patient came to CSC, they immediately met with a program navigator who began the patient support process. Since COVID however, CSC determined they could achieve a significant level of care through intentional videos. CSC thus chose to use the Survivor Circle Grant to develop a series of introductory videos focusing on how supportive care can improve their participants’ lives.
Three videos were created: “What to Expect at The Cancer Support Center,” “Why Supportive Care is so Valuable,” and “What Supportive Oncology Care is and How it Can Help.” These videos are housed on CSC’s YouTube page, as well as embedded in their website at strategic points of entry for interested participants. Opportunities are abundant as CSC continues to find new ways to share the videos and spread the message of CSC and the importance of psychosocial oncology care. Challenges included staff ease in front of the camera, ensuring that scripts encompassed the wide range of topics associated with each area and needing to be engaging and concise.
Funds were spent on staff time (Executive Director, Marketing Manager, Marketing Coordinator for development of the video content and marketing; Executive Director, Clinical Program Director, Program Manager, Program Navigator and two staff therapists to rehearse and shoot the video content) and Videographer.
This project has made it easier than ever for CSC to share who they are, what they do and why it is important. They have already utilized the video content on their website, social media platforms and in presentations with external partners. From introductory presentations about CSC to hospitals and businesses, to hospital staff sharing with patients — the reach is vast. CSC had heard that it is difficult for participants to think about coming to CSC, and the video series is helpful to bridge the gap of conveying what to expect. For example, hospital staff shares the video with patients or upper management to communicate CSC as a resource or to explain the importance of psychosocial care in general. The full potential of the videos’ reach is still being discovered, and they anticipate using them for years to come to encourage higher participation and referrals, and also to incorporate psychosocial care into the experience of all cancer patients.
Similarly, the LivingWell Cancer Resource Center, the other recipient of the 2021 Survivor Circle Grant, expanded their breadth of reach using the new funding, but in a more physical way. Upon receiving the funding, their social work team mobilized to support patients needing transportation to and from appointments. The grant removed a barrier to patient care in the most practical way, as many LivingWell participants tend to rely on rides from family, friends or caregivers. When rides are not available, patients often have no choice but to cancel their appointments, delaying much-needed care.
The Survivor Circle Grant has helped LivingWell Cancer Resource Center reinforce their efforts to provide a foundational component of their purpose, increasing access to care. From November 2021 through October 2022, LivingWell funded a total of 175 rides, totaling almost $7,000. The average ride distance was 12 miles, with the furthest distance traveled as 49 miles, to various Northwestern Medicine Cancer Centers.
Alongside the grant, LivingWell bolstered their efforts with other partnerships, including the American Cancer Society, which is piloting its Road to Recovery program, using community volunteers to provide rides in DuPage and Kane counties. However, the limited number of available drivers has been an obstacle, as the demand for rides far outpaces the availability of drivers. The program has not yet been piloted for the DeKalb community, and because of these challenges, ASTRO funding has been instrumental in providing access for patients to receive care. The social work team works with patients to determine alternative options to support visits for patients’ long-term medical needs, including investigating family, friends and community resources to provide rides along with assessing the patient’s health plan to see if transportation might be included in their coverage. If not, the team often works with the patients to change to a plan that includes this coverage without sacrificing medical coverage for care.
Through the year, LivingWell’s social work team made every effort to exhaust every other possible resource before considering Uber Health as an option. To offset the cost of inflation and increasing gas prices, LivingWell will use remaining funds to purchase $25 gas cards, which will help 130 patients through the remainder of 2022.
The Cancer Support Center and LivingWell Cancer Resource Center have used their funds to multiply their impact. Similarly, we encourage cancer support organizations in next year’s Annual Meeting state, California, to consider how they too might strengthen their support. Applications will open up in January 2023 and be due in the spring. For questions, contact Beth Bukata.
Read about the 2022 Texas-based Survivor Circle grant recipients.
By Constantine Mantz, MD, FASTRO, Chair ASTRO Health Policy Council, and Anne Hubbard, ASTRO Director of Health Policy
On November 7, the Center for Medicare and Medicaid Innovation (CMMI) issued Person-Centered Innovation – An Update on the Implementation of the CMS Innovation Center’s Strategy. The “update” report builds on the October 2021 Innovation Center Strategy Refresh document by establishing baselines and targets for each of the following five key objectives:
- Drive accountable care.
- Advance health equity.
- Support innovation.
- Address affordability.
- Partner to achieve system transformation.
CMS also introduced a strategy to improve access to high-quality integrated specialty care focused on four key areas:
- Enhance transparency in clinician performance.
- Continue deployment of episode payment models that align with ACOs and primary care, including mandatory models.
- Support specialists to further embed primary-care focused models.
- Create incentives within population-based models to encourage specialty care integration.
According to the document, CMMI plans to assess data shared in current specialty and population-based models and programs and determine how it can be refined and enhanced to support greater coordination and integration between primary and specialty care. The Agency specifically points to the Comprehensive Joint Replacement (CJR) Model, Bundled Payments for Care Improvement (BPCI) Advanced and Enhanced Oncology Model (EOM) as examples of episode-based payment models that can be used to align incentives between specialists, primary care and Accountable Care Organizations (ACOs).
Additionally, the Agency highlights recent modifications to the BPCI-Advanced model that are designed to maintain momentum among providers and health systems that are participating in that program. Specific modifications include a two-year extension of the model and a reduction of the discount factor from 3% to 2%, as well as a reduction in the Peer Group Trend Factor Adjustment from 10% to 5%. CMMI hints that it will be releasing a new mandatory episode-based payment model that builds on the lessons learned from the BPCI, BPCI-Advanced and the CJR models. The Agency does not provide any details about this new mandatory initiative other than to say that it believes a mandatory approach can improve and standardize care for beneficiaries across hospital-based and post-acute care transitions, while also avoiding risk selection in participation decisions. The Agency also underscores its commitment to models that focus on special patient populations, including patients with cancer, with the implementation of the EOM in July 2023.
Finally, CMMI is seeking opportunities to create financial incentives for specialists to affiliate with population-based payment models, allowing more specialists to move toward value-based payment. This includes establishing incentives that allow for greater management and integration of specialty care within population-based models.
Implications for Radiation Oncology
The update represents a renewed interest in episode-based payment models. This is a shift from the prior Strategy Refresh document, which indicated that the Agency was focused on the establishment of broader total cost of care (TCOC) and ACO concepts. Since the issuance of the Strategy Refresh document, and the subsequent introduction of the REACH Model, which was an ACO concept, the Medicare Payment Advisory Commission (MedPAC) and the Physician Focused Technical Advisory Committee (PTAC) have raised questions regarding the implications of broader approaches to value-based payment. These discussions have included interest in exploring episode-based approaches for distinct components of care that can be nested within broader value-based payment programs. These discussions seem to have not only influenced the document but also given CMMI an opportunity to consider revisions to existing episode-based payment models that incentivize participation, such as the BPCI-Advanced payment methodology revisions that reduce financial risk.
While it is disappointing that the Agency remains committed to mandatory models, the focus on revising payment methodologies to incentivize participation is a positive development. Additionally, CMMI’s renewed interest in episode-based payment and integration of specialty care into broader value-based payment initiatives indicates that, while the RO Model has been indefinitely delayed, the Agency is establishing a pathway for similar concepts to be implemented. This underscores the importance of continuing ASTRO’s efforts around payment reform, particularly related to episode-based payment model development approaches that stabilize payment, protect access to care and ensure appropriate use of radiation therapy in the treatment of cancer.
For more information about the program, CMMI will be hosting a Specialty Care Strategy Listening Session on December 1, 2022, at 1:00 p.m. Eastern time. This event will cover the following topics:
- Overview of CMS Innovation Center Specialty Care Models and the rationale for focusing on specialty care integration.
- Overview of the Specialty Care Strategy.
- Guest panelist feedback on the Specialty Care Strategy.
By Randi Kudner, Assistant Director of Quality Improvement
Four years ago, ASTRO realized it was time to tackle the issue of access and availability of radiation oncology clinical data. The 2018 publication of the Minimum Data Elements for Radiation Oncology (MDE) was ASTRO’s first step in a Herculean effort toward easing the daily burden of practices. In 2021, Christodouleas et al. provided background in an ASTRO blog post, explaining how the MDE paper was leading to real world outcomes. While ASTRO’s original goal was to develop a way to automatically generate end-of-treatment summaries, the potential has proven to be much greater.
How has ASTRO found a path forward?
During the development of MDE, ASTRO took a calculated leap of faith and joined the Common Oncology Data Elements eXtension (CodeX) initiative during its early days. ASTRO is a founding member of CodeX and sits on the minimum Common Oncology Data Elements (mCODE) Executive Council. ASTRO encouraged involvement from the American Association of Physicists in Medicine (AAPM) and the collaboration has made a huge impact. For years, siloed data projects have been happening, but there hasn’t been an opportunity to move the development in the same direction. CodeX, under the leadership of the MITRE Corporation, has provided that partnership and a forum for many disparate oncology data projects to come together and move toward the same goal. MITRE has provided the technical informatics knowledge that specialty societies, like ASTRO and AAPM, and radiation oncology practices may lack. This technical support has allowed ASTRO and AAPM members to translate complex clinical scenarios into machine readable and transferable information and will soon ease some daily burdens in radiation oncology practices.
In the 2018 ASTRO Membership Survey, 20% of respondents stated that using electronic health records was a key concern in daily practice. Siloed and non-transferable data is an issue throughout health care, and radiation therapy is no different. As a member of CodeX, ASTRO has led the charge to change the status quo of radiation therapy data and, in partnership with AAPM and many vendors, has created solutions to help daily practice. The collaboration between ASTRO and AAPM has been highlighted as the successful model in CodeX. This recognition can be seen in the recent appointment of CodeX Steering Committee representatives from ASTRO (Adam Dicker, MD, PhD, FASTRO, FASCO) and AAPM (Chuck Mayo, PhD, FAAPM, FASTRO). These radiation oncology delegates will shape the future of the initiative and oncology data.
Treatment Summary Automation
Care coordination is central to the experience of patients and caregivers, particularly with cancer care, as they navigate multiple treatment modalities, clinicians and health care settings. To date, the creation of end-of-treatment summaries, a key part of care coordination, has remained a painfully manual process. The work that ASTRO and AAPM have done through CodeX has primarily focused on correcting this issue. Through this multi-year endeavor, radiation oncology-specific vendor systems have automatically aggregated treatment summary data and transferred it successfully to enterprise. This is a huge step forward from the current manual creation of these documents that transmit as an unusable pdf to other systems. Varian, Epic and RaySearch have all successfully tested this functionality and are currently developing implementation plans for their commercial offerings, meaning it should be coming to your practice soon!
Meaningful quality measures
Members of the radiation oncology team, like all health care professionals, are driven by their desire to improve patient outcomes. Measurement is a key component of any sort of improvement, but quality measures have been burdensome, and the aggregated data is normally meaningless. ASTRO’s CodeX work, in parallel with Telligen, a federal contractor, and ASCO, is changing the ability for practices to collect data that are integral to understanding meaningful quality and safety gaps, while also providing insight into treating the whole individual. The CodeX quality measures team is currently updating common measures to assess care provided to different populations, stratifying by gender, race and ethnicity. Once finalized, ASTRO will use the framework to create new quality measures for radiation oncology practices. These modern measures will be critical to measuring and improving the quality of care and essential to promoting equitable health outcomes.
Streamlined prior authorization
Prior authorization has long been a thorn in the side for radiation oncology practices.1,2 While informatics does not resolve the obtrusiveness of prior authorization, it can go a long way to ease burdensome data collection and reporting. Clinical data are essential to ensuring accurate clinical representation for the decision support needed to ensure the right treatments for the right patients. ASTRO is engaged in another CodeX project to reduce clinician and health system burden by developing an informatics solution using the approaches referenced in the Centers for Medicare & Medicaid Services’ (CMS) interoperability rules. Starting with prostate and breast radiation therapy, ASTRO is working with Varian, US Oncology and EverNorth to define an automated prior authorization process using health care data standards to extract and exchange the necessary information to expedite the prior authorization process.
What is next?
Vendor systems have several compliance requirements to meet by the end of 2022 which help support ASTRO’s work toward breaking down the barriers of health care data. Vendors, oncology practices and multidisciplinary oncology groups are engaged with ASTRO and CodeX to make an impact in the future of cancer data. ASTRO has led the way and will continue working to help ease the daily burden related to health care data. ASTRO cannot do it without you; radiation oncology practices need to get involved and to let vendors know that these solutions are needed as soon as possible. Contact Randi Kudner, ASTRO’s Assistant Director of Quality Improvement, to learn how you can get involved with CodeX and ease the burden in your own practice.
- Bingham B, Chennupati S, Osmundson EC. Estimating the Practice-Level and National Cost Burden of Treatment-Related Prior Authorization for Academic Radiation Oncology Practices. JCO Oncol Pract. 2022;18(6):e974-e987.
- Committee activity. Committee on Small Business. https://smallbusiness.house.gov/calendar/eventsingle.aspx?EventID=2794. Accessed October 26, 2022.