The final post in a three-blog series, ACCCBuzz spoke to Megan Morava, PA-C, and Alexandra Greenawalt who share how one independent oncology practice and local community center are taking action to improve equitable cancer care delivery at the local level. Read the first and second post of this series online.
Megan Morava is a physician assistant at Carolina Blood and Cancer Care Associates and the operational lead for the practice’s No One Left Alone (NOLA) initiative. With NOLA, Morava oversees the initiative’s data collection to improve the practice’s understanding of how social determinants of health (e.g., transportation barriers, housing instability, employment challenges, medication access, and more) impact cancer care. Along with her colleagues, Morava developed the NOLA intake form that is provided in new patient information packets and oversees the initiative’s paper-based data collection process.
Most of NOLA’s screening questions require a simple “yes” or “no” answer, so the form is easy for patients to complete. “As far as collecting all of this information, it’s still early stages, but we’ve already seen good results,” Morava said. “It’s a multi-level effort. The front desk will sometimes give patients the form or the medical assistants will.” Next steps are simple. The intake forms are collected and a staff member with a dedicated data entry role will enter patients’ answers into a master spreadsheet. This spreadsheet has a “social needs” tab where patients’ unmet needs are summarized. Through data organization, Morava can monitor the spreadsheet so that patients can be connected with resources in the community.
Another key aspect of the NOLA initiative is improving routine cancer screening rates among Carolina Blood and Cancer Care Associate’s patient population. To meet this need, the master spreadsheet can be filtered to identify patients who are missing routine cancer screening. “We’re getting a lot of valuable data,” said Morava. “Even if it’s as simple as learning that some people don’t have a primary care provider.” Without the NOLA intake form, Morava states that the practice would not be able to gain this necessary patient information. “If patients are referred from the ER, that [data] can get missed,” she said.” It’s just matter of asking the questions.”
Discovering Community-Based Resources
Yet, from the beginning, NOLA staff faced a significant challenge: once patients’ unmet needs were identified, how would the practice help direct patients to necessary support services? “We can give patients a packet of information, a pamphlet, or [information on] resources, which we do,” said Morava. “But there needs to be some other way that we can help them.” Then, in January 2022, the NOLA team and Dr. Kashyap Patel, chief executive officer at Carolina Blood and Cancer Care Associates, president of the Community Oncology Alliance, and a South Carolina Oncology Society Board Member, learned about an incredible local resource.
Pathways Community Center is just under a mile from Carolina Blood and Cancer Care Associates’ Rock Hill clinic. With an overarching aim to address health disparities in York County, S.C., “Pathways provides a physical space and framework that brings together local support service providers in a one-stop shop,” explained Alexandra Greenawalt, executive director at Pathways Community Center. Pathways creates a collaborative hub of services that are addressing various aspects of health disparities in the York County community—from access to healthcare and transportation to food insecurity and more. “Whether they [community members] are referred from Dr. Patel’s office or they are locals in the community that are vulnerable, they can come here and not have to travel near or far to get what they need,” said Greenawalt.
The 40,000-square-foot Pathways Community Center rents space to its collaborating organizations. Currently, the facility is at capacity, housing 15 agencies on-site. However, Greenawalt said that representatives from additional organizations are invited to Pathways to share information on their resources for those in need. “When someone walks through the door, generally they have a laundry list of needs,” said Greenawalt. “The beauty of Pathways is [that] we sit down, and we go through a formal, standard assessment to determine what those needs are. And we also get a background on the person. Then we are able to give a ‘warm hand off.’” Pathways staff will introduce individuals to the agency that will help with their identified need(s).
Data collection is critical to Pathways’ model. “We are the evidence-based model of a collective framework,” Greenawalt said. “We are the space, the facility, and we bring on the leadership to make sure we are measuring outcomes and working in unity for the common good.”
When the Carolina Blood and Cancer Care Associates’ NOLA initiative screening process identifies patients with needs like transportation, insurance coverage, and financial assistance; housing instability or lack of housing; and/or food insecurity, Morava and her colleagues will direct eligible patients to Pathways for help. In making referrals, a NOLA team member will call ahead to let the Pathways team know that an individual is being referred, and Pathways will complete a comprehensive intake for them.
Can These Models Exist Elsewhere?
Greenawalt and Morava believe their models are replicable. “I think you have to have the right partners in the community,” said Greenwalt. “And if you don’t, you [should] start to establish relationships with agencies that exist. Work with them to show that there is grant money out there that can help bring on a new program under your umbrella that can expand the scope of what you do.”
As a leader on the NOLA team, Morava believes their model could be replicated in other oncology practices. “I would absolutely encourage any other practice to implement something similar,” she said. “When you’re in a specialty like we are, it can be easy to view each patient in such a narrow context. But the reality is [that] there are so many other factors that influence their [patients’] care. By gathering the data and addressing social and health needs, we can try to minimize all the disparities in care. Even if it sometimes seems like it’s on such a small scale, that’s almost what you need to make change in a community. You have to start somewhere.”
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