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Phase One: Research and Beta Model Development

Research: Environmental Scan & Development Site Visits

Development of the Improving Care Coordination Model began in 2016 with a bibliography and an  environmental scan to better understand the current state of care access and coordination for patients with lung cancer covered by Medicaid, identify barriers and challenges, and review existing studies that included potential strategies to improve care coordination for this patient population.

The scan incorporated a literature review and insights from  members of the project’s interdisciplinary Advisory Committee, a lung cancer survivor and patient advocate, and multidisciplinary health professionals from two ACCC-member cancer programs. Among the scan’s key findings:

  1. The financial and social barriers that Medicaid beneficiaries face in pursuing lung cancer treatment are significant, detrimental to outcomes, and largely unaddressed. These include:

    • Accessing reliable transportation 

    • Taking time off from work/lost incomes 

    • Procuring childcare or other family support 

    • Covering out-of-pocket expenses for services and drugs 

  2. Medicaid beneficiaries have unequal access to high-quality care. Disparities in care access can be attributed to multiple causes, including how patients typically access the healthcare system. 

  3. Increasing patient engagement is critical to improving outcomes but will require a tailored approach given the unique challenges Medicaid beneficiaries face.  

  4. Integration of patient navigators into the care team can promote Medicaid beneficiaries’ access to timely, high-quality care. Both clinical and non-clinical navigators may play a key role in ensuring access to care, coordination of services across providers, education, and follow-up to promote adherence to treatment recommendations. 

  5. Multidisciplinary teams are key to improving care coordination. Opportunities may exist to strengthen and build on the team approach to caring for patients with lung cancer.

  6. Improvement is needed to promote timely access to supportive services for this patient population, including attention to biopsychosocial needs, palliative care needs, survivorship issues, hospice, and end-of-life care. 

Development Site Selection

The Advisory Committee and ACCC staff used results from the environmental scan to develop an application and criteria for the selection of Development Sites that would participate in comprehensive interviews to map out existing care pathways for Medicaid patients with lung cancer.* Over the next several months, the ACCC project team traveled to the five Development Sites. Using a standardized interview protocol, the team completed in-depth interviews with cancer program staff, including both clinical and administrative personnel; patients insured through Medicaid; palliative care and hospice providers; the interdisciplinary care team involved in the diagnosis and treatment of patients with lung cancer; and healthcare staff from referring practices and healthcare facilities. 

Comprehensive reports provide snapshots of each site’s successes and challenges in providing care for patients with lung cancer, with a focus on individuals insured by Medicaid or without healthcare coverage. These reports were published on the ACCC website in late 2016. Below are the five Development Sites and their reports.

*Note: Under the terms of the grant, programs in the following states are excluded from participation in this project: AL, GA, KY, MS, NC, TN, SC, and WV.

Beta Model Development

Informed by the environmental scan and the Development Site reports, the project’s expert Advisory Committee convened an in-person meeting in November 2016 to discuss key findings in the context of model development. Ultimately, consensus developed around the concept of a beta Care Coordination Model built directly upon the Multidisciplinary Care (MDC) Assessment Tool created by the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP), a project funded by NCI from 2007-2014.

The NCCCP pilot, which eventually engaged 30 participating hospitals and health systems across the country, sought to build a community-based research platform to support a wide range of basic, clinical, and population-based research on cancer prevention, screening, diagnosis, treatment, survivorship, and palliative care at community hospitals—contributing to enhanced quality of care for patients and advancing cancer research. Learn more.

To enrich Model development, ACCC formed a Technical Expert Panel (TEP). All members of the TEP were former NCCCP pilot participants. The TEP collaborated with the Advisory Committee and the ACCC project team to draft a beta version of the Care Coordination Model. The beta Model consisted of 13 assessment areas. Each assessment area had five levels—level 1 represented the most basic provision of care and level 5 represented optimal best practice for care coordination.