ACCC’s Landmark Cancer Community Survey Turns 10

Now in its 10^th year, ACCC’s Trending Now in Cancer Care survey continues to bring into focus the proactive and reactive responses of cancer programs to shifts in the business of cancer care delivery. As they have throughout the past decade, in 2019, survey respondents nationwide told ACCC how they are handling the intersecting levers of change that continue to buffet oncology care. As developments in science, business, industry, policy, and patient and provider concerns continue to evolve, ACCC’s Trending Now survey helps clarify the most relevant challenges and opportunities facing the cancer care community.

Conducted by ACCC in partnership with the Advisory Board’s Oncology Roundtable, the 2019 survey was distributed via email in fall 2019 and received 144 responses from individuals at 126 organizations. Despite a volatile reimbursement climate and the challenges that accompany value-based care models, cancer programs continue to find innovative ways to meet a rising demand for patient-centered care.

Cancer practices say the top three services or programs they plan to add or grow this year are survivorship visits or clinics, palliative care consults, and navigation. Additional plans to grow services in genetic counseling, oral chemotherapy adherence and support, and financial advocacy indicate an ongoing demand for comprehensive cancer care.

Top Challenges: Payer Reimbursement, Value-Based Care

When asked to identify the top threats to future cancer program growth, nearly half of respondents (49 percent) cited payer reimbursement requirements (slightly up from 48 percent in 2018). The shift of reimbursement from fee-for-service to value-based care ranked second (48 percent; up from 30 percent in 2018). Also of concern are uncertainties in drug pricing reform policies (40 percent) and the cost of new treatment processes and equipment (37 percent). Notably, the cost of drugs as a top concern was down from 48 percent in 2018 to 34 percent in 2019.

Top Cost-Saving Opportunities: Care Coordination, Symptom Management

For many cancer programs, expanding supportive care service lines is often paid for by cost-savings or cost-containment efforts. Asked to identify the top opportunities for cost savings, a significant majority of respondents (88 percent) named improving care coordination, up significantly from 41 percent in 2018. Eighty-five percent of respondents named improving symptom management as a cost-savings opportunity, compared to 54 percent in 2018. Seventy-six percent of respondents said using lower-cost drugs was a cost-savings prospect for them, up from 42 percent in 2018.

Survey highlights

• Workplace concerns: With burnout prevalent among healthcare workers, survey respondents cited a number of workplace concerns:
  • Workflow inefficiencies (75 percent)
  • Heavy workloads (58 percent)
  • Staff complaints about workload and burnout (58 percent)
  • Lack of work/life balance (40 percent)
  • Decreasing focus on patient care (24 percent)
    
• Telehealth: Survey results revealed limited adoption of telehealth in cancer care delivery. Asked to name the top four services they currently provide via telehealth, respondents cited tumor boards (45 percent), genetic counseling (32 percent), molecular tumor boards (24 percent), and second opinions (16 percent). A number of respondents say they plan to leverage telehealth for multiple services during the next two years, including:
  
  • Genetic counseling (35 percent)
  • Symptom management consults (28 percent)
  • Oral chemotherapy adherence and support (28 percent)
  • Symptom monitoring (28 percent)
  • Psychosocial counseling (24 percent)
  • Nutrition counseling (22 percent)
  • Financial navigation (21 percent)
  • Survivorship visits (21 percent)
  • Tumor boards (21 percent)
    
• Staffing needs: Retaining adequate staff to ensure access to quality care for all patients is an ongoing challenge. The positions cancer programs report being most concerned about filling are medical oncologists (59 percent), oncology nurses (53 percent), financial advocacy staff (49 percent), navigators (44 percent), and palliative care specialists (43 percent).
  
• Clinical trials: Survey results reveal a number of ongoing challenges to offering patients access to clinical trials. More than half (53 percent) cite inadequate staff resources and training, 50 percent cite inadequate program infrastructure, and 46 percent cite lack of patient understanding of the clinical trial process.
  

During the past decade, ACCC’s Trending Now in Cancer Care survey has provided an annual comprehensive picture of the evolution of cancer services and care delivery at programs and practices nationwide. While some concerns have resolved with time, others remain as intractable as ever. As oncology care enters the third decade of the new millennium, the Trending Now survey will continue to take the pulse of the provider community. ACCC President Ali McBride, PharmD, MS, BCOP, calls the annual survey, “a real-world reference point that cancer programs large and small can utilize as they navigate the multisector changes in healthcare.”