OCCM top banner 2000x167
Home / Improving Care Coordination / Improving Care Coordination Overview

Improving Care Coordination Overview

The Association of Community Cancer Centers (ACCC) has created a model framework (the Model) for cancer care providers to use in improving care coordination for lung cancer patients covered by Medicaid. A three-year grant from the Bristol Myers Squibb Foundation provided funding for development of the Model.

Guided by an interdisciplinary Advisory Committee, led by physician champion co-principal investigators, and a Technical Expert Panel, ACCC developed the Model in three phases:

Phase One—Research and Beta Model Development
Learn More

Phase Two—Testing the Beta Model
Learn More

Phase Three—Data Analysis and Outcomes
Learn More

The Model

Care Coordination Model Thumbnail

ACCC is pleased to make available the Model for Improving Care Coordination, which is designed for programs and practices of all sizes and resource levels. In addition to being a comprehensive PDF report, the Model has been transformed into a free, interactive online tool to evaluate the current state of care coordination for lung cancer patients and identify focus areas for improvement and actionable next steps.

Beyond a framework for evaluation and setting quality improvement priorities, the Model aligns quality improvement (QI) with existing quality measures, including those from the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (CMS MIPS), the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO QOPI), the National Committee for Quality Assurance Patient-Centered Specialty Practice Recognition (NCQA PCSP), the Agency for Healthcare Research and Quality Consumer Assessment of Healthcare Providers and Systems (AHRQ CAHPS®), and the Commission on Cancer (CoC) 2020 Cancer Program Standards.  

The Model has 12 assessment areas, each with a high impact on optimal care coordination for lung cancer patients. The assessment areas start at the time of initial patient referral to cancer services and continue through survivorship and end of life. Each assessment area is divided into 5 levels. Level 1 attributes represent basic care and coordination; Level 5 attributes represent optimal best practice. The Model includes a crosswalk of assessment areas to quality measures.

From Oncology Issues

Abstracts & Presentations



News & Media


If you have any questions, please contact Amanda Kramar, Chief Operating Officer, ACCC.

Our Supporter

BMS-Foundation-300x110 Support provided by Bristol Myers Squibb Foundation

What They’re Saying


The care coordination tool [the Model] really helped us formally evaluate our program. We knew that patients diagnosed with lung cancer were getting lost in our system. We had a lot of late-stage lung cancer patients, and we needed to improve our case planning so we could identify those patients sooner.

— Sherri Costa, MS, RN, AOCNS, Manager of Cancer Support Services & Quality Improvement Coordinator, Ascension Wheaton Memorial Medical Center