Despite immense advances in medicine, cancer continues to be an incredibly prevalent and life-altering illness. In the United States alone, more than 1.5 million people are diagnosed with cancer each year. A large portion of those diagnosed with cancer are older adults, over the age of 65. Since this medically complex population often comes to a cancer diagnosis with multiple comorbidities and social stressors, the need for robust, coordinated care is paramount (Centers for Medicare and Medicaid Services [CMS], 2018).
 

In 2016, the Center for Medicare and Medicaid Innovation (CMMI) launched a demonstration project to provide improved cancer care to older adults. This five-year initiative, “The Oncology Care Model,” (OCM), is focused on Medicare Fee for Service beneficiaries who are receiving chemotherapy treatment. The goal of the program is to promote transformation within oncology practices by enhancing the services and coordinated care Medicare beneficiary patients receive. In turn, the hope is that effective care will also help lower health care costs. These goals are met by offering patient-centered navigation services, 24/7 access to an appropriate clinician and a 13-component care plan (CMS, 2018). Currently, 184 practices and more than 6,500 practitioners throughout the country are participating in OCM (CMMI, 2018). These numbers demonstrate that many oncology practices around the United States are looking for inventive ways to transform the care they are providing to older adults.

I have the privilege of participating with OCM as a social worker at New York Oncology Hematology (NYOH). NYOH is a private, physician-owned, community-based, oncology and hematology practice in the Albany, NY, area. It is the largest provider of oncology and hematology care in New York’s Greater Capital Region and offers care at seven sites. NYOH has been providing care for more than 30 years and has a team of more than 40 providers. The mission of the practice is to provide “World Class Cancer Care. Close to Home.” NYOH offers treatment options in the areas of medical oncology, radiation oncology, neuro-oncology, stem cell transplant and hematology. NYOH also has an affiliation with the U.S. Oncology Network and facilitates the largest clinical research operation in the area.

NYOH’s mission of providing research-driven, world-class care aligns well with OCM’s goal of practice transformation. NYOH saw OCM as a venue to offer even more highly coordinated care to our older adult patients. At NYOH, the “OCM Team” is interdisciplinary and comprised of nurse navigators, social workers and patient care coordinators. The team is supported by NYOH’s Clinical Services Director, physicians and the entire staff. The support of all NYOH staff has enabled the OCM Team to transform and improve the care our older adult patients are receiving.

The NYOH OCM Team promotes improved care by offering high-touch navigation services. This starts by completing a thorough initial assessment where the nurse navigator and social worker assess strengths, stressors and, most importantly, the patient’s goals. Based on this assessment, the OCM Team creates a care plan that highlights strengths, eases stressors and promotes the patient’s objectives. This assessment opens the door to offer other OCM services, including advanced care planning sessions, social work support, palliative care and survivorship counseling.

One service the OCM Team has incorporated with much success is the family meeting. This intervention is based on the Family Meeting Model, which recognizes that patients undergoing cancer treatment, especially older adult patients, don’t enter their journey in a vacuum. Most often, they start their cancer journey with the involvement of family and friends, as well as with other chronic medical and social stressors. Therefore, it is important to early on create a space for open communication among the patient, their loved ones and the medical team. By facilitating family meetings, the OCM team can better appreciate a patient’s view of their disease, how the patient and family are coping, other stressors they may be facing and their hopes for the future. Through having these open conversations at the start of treatment, the OCM team can help transform the patient’s oncology care from a reactive to a proactive experience (Collea, Pulver, Ralli, & Burgess, 2017). Through OCM, we have gained greater understanding that the earlier patients are able to talk openly about the entirety of their cancer journey, the sooner services can be put in place to ease that journey.

The new and enhanced services NYOH has incorporated into their practice embodies the goals of OCM. NYOH has been able to offer high touch, coordinated care to many older adults due to our participation in OCM. The OCM Team has been able to assist older adults with cancer, who are often facing multiple stressors, access services that manage these challenges. Most importantly, interventions such as the family meeting enable patients to remain at the center of their care by having a safe space to articulate not only their concerns but also their goals. Furthermore, NYOH has experienced its own evolution since participating in OCM. For example, OCM enabled NYOH to incorporate social workers and nurse navigators into the practice. Additionally, palliative care, which started as an OCM service, is now offered to all NYOH patients. These changes illustrate how demonstration projects such as OCM not only assist patients immediately, but also can help practices make lasting changes. The goal is that these changes will provide enhanced oncology care while also lowering healthcare costs. As we look to the future, the hope is that more initiatives like OCM will be available to oncology practices. In turn, oncology care can continue to be transformed from treating not only the disease, but also caring for the individuals and families facing a cancer journey.

References

Centers for Medicare and Medicaid Innovation. (2018, May). Oncology Care Model Overview. https://innovation.cms.gov/Files/slides/ocm-overview-slides.pdf

Centers for Medicare and Medicaid Services. (2018). Oncology Care Model. Retrieved from: https://innovation.cms.gov/initiaitves/oncology-care

Collea, R., Pulver, L., Ralli, C, & Burgess, A. (2017). Transitions in cancer care-Moving from crisis intervention to care planning and management. Evidence Based Oncology: