The second post in a three-blog series, ACCCBuzz shares how one independent oncology practice is taking action to improve equitable cancer care delivery at the local level, potentially creating a replicable model for providers in the community. Read the first post of this series online.
Before launching the No One Left Alone (NOLA) initiative, Carolina Blood and Cancer Care Associates had one full-time staff member dedicated to helping patients with cancer access financial support resources. But their workload becoming overwhelming and more precise tracking of financial advocacy data was needed. “We analyzed each aspect of cancer health disparities,” said Kashyap Patel, MD, who is president of the Community Oncology Alliance (COA), chief executive officer of Carolina Blood and Cancer Care Associates, and a South Carolina Oncology Society Board Member. “We focused on access to care and socio-economic factors and decided to mobilize our own resources.” In 2021, the practice hired additional staff, bringing the total to 2.5 full-time equivalent staff dedicated to addressing socio-economic barriers to care access. The practice's staff were all brought into the discussion, and everyone committed to the initiative. As part of its commitment, Carolina Blood and Cancer Care Associates self-funded the additional staff positions.
Phase 1: Access to Care
The NOLA initiative officially launched in spring 2021, encompassing the South Carolina counties of York, Lancaster, Chester, Cherokee, and Kershaw. Phase 1 of the initiative is focused on identifying patients who are uninsured or underinsured, collecting data related to social determinants of health, obtaining legal assistance for those seeking Medicaid and dual eligibility determinations, and locating sources of funding for Medigap insurance coverage.
At patients’ first visit, NOLA staff determine patients’ health coverage status. Insured individuals meet with the practice’s dedicated financial counselor, who reviews their benefits and identifies any unmet needs. The practice collects information to discern whether patients are likely to need help with additional costs during their treatment (e.g., utilities, gas or transportation costs, food or housing insecurity, etc.)
The NOLA screening process has revealed that close to one-quarter (20 percent to 25 percent) of patients covered by Medicare did not have Medigap supplemental insurance. Without supplemental coverage, these patients are responsible for Medicare’s 20 percent co-pay. Screening data then showed that five to seven percent of patients were uninsured. Although Carolina Blood and Cancer Care staff were assisting these patients with Medicaid enrollment, the process often took months. “Cancer does not wait three to six months,” Patel said. Through NOLA , the practice reached out to their local congressional office’s staff for help in overcoming hurdles to Medicare and Medicaid coverage for oncology patients.
During Phase 1, NOLA staff coordinated care and access to the following services/resources to alleviate patients’ unmet needs:
Utility support (the local utility company facilitates a payment waiver for patients with advanced cancer with a life expectancy of less than a year)
Local gym membership fees are waived
Gas cards through the American Cancer Society and Pathways—a local community organization
Local charity organizations for additional support, such as transportation and utility assistance or help in accessing benefits, housing, and/or food
Local congressional office, which helped expedite qualifying applications through the Department of Social Services and state Medicaid program
A list of foundations—updated weekly—to help identify available grants.
Phase 1 data highlights (as of March 2022) include:
319 patients received cancer treatment; nearly half (154 patients) needed some type of financial assistance that was provided through NOLA.
53 patients were able to obtain free medicines through manufacturer-based patient assistance programs.
Between help with out-of-pocket costs and/or free treatment for 154 patients, NOLA staff secured direct and indirect contributions of $11,490.38.
NOLA staff obtained $1,769,520.58 in patient financial help for parenteral medications.
No patients were forced to disrupt or stop treatment due to financial concerns.
In taking the total out-of-pocket costs for all patients, an aggregate of less than one percent were patients’ responsibility, Dr. Patel said. Therefore, patients could prioritize their recovery rather than worry about having to stop their treatment due to financial burden.
Phase 2: Access to Biomarker Testing
The role of biomarker testing in cancer diagnosis and treatment planning, as well as in eligibility for clinical trial participation, continues to grow. And Dr. Patel is passionate about improving awareness of and access to biomarker testing for patients with cancer. For Phase 2 of the NOLA initiative, Carolina Blood and Cancer Care Associates partnered with two, large national labs for prospective tracking of patient demographic data to identify individual and system-level barriers to achieving guideline concordant biomarker testing. Patient data collected include literacy level, insurance status, and financial barriers in relation to biomarker testing rates. From June 1, 2021, through December 2021, data show that the practice increased biomarker testing in concordance with national recommendations from 37 percent to 84 percent for eligible patients.
Phase 3: Access to Clinical Trials, and more
NOLA’s Phase 3 began in February 2022, as Caroline Blood and Cancer Care Associates takes a deeper drive into the factors comprising social determinants of health, including barriers to receiving recommended cancer screenings, and exploring ways to overcome challenges to clinical trial access. When it comes to improving equity in oncology clinical trials, however, Dr. Patel remains concerned. “If you look at the profiling of practices based on size and location, unless pharmaceutical companies open to the doors to be more inclusive to bring more diversity, I think we will continue to perpetuate disparities,” he says.
Taking Care of What Can Be Seen
During the past two years, Dr. Patel and his colleagues at Carolina Blood and Cancer Care Associates have researched, collected data, and designed the NOLA Initiative to address disparities in the community at the practice level. Based on the journey so far, Dr. Patel is optimistic about addressing financial barriers, boosting screening rates, and increasing biomarker testing in the community through screening, data collection, staff dedication, and strong collaborations between all community healthcare stakeholders. These are facets of quality cancer care delivery over which he believes oncology practices can exert some control.
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