Primary Care Physicians are integral in supporting our mission to improve the cancer care experience for health plans, clinicians, and members.
PCPs sit at the core of patient care.
Beyond managing the multitude of things that come into their office on a daily basis, PCPs play an essential role in helping their cancer patients through the complexity of cancer care, and the status of current systems can make that difficult.
I’m a medical oncologist. I take care of cancer patients. And I think I’m reasonably good at it, partially because that’s all I take care of: cancer. I don’t know how to manage congestive heart failure anymore. I can’t spell or pronounce most of today’s diabetes drugs. If I tried to perform surgery… let’s not go there except to say that would be quite problematic. As healthcare becomes more complex, it’s increasingly important that clinicians specialize in the problem for which they are trained. For oncologists, that’s cancer. And that means that I rely on my expert colleagues for help in areas beyond my expertise.
More than half of all cancer patients have at least one comorbidity, and this proportion rises to nearly two thirds in those aged 75 and older (1).
When I’m treating my patients with lung cancer for example, many of them may have COPD or coronary disease, and those things need to be managed by their PCP. The need to manage these comorbidities doesn’t stop, and the knowledge of the drugs that oncologists use and how they interact with other drugs is important, but all of this cannot be and should not be the sole responsibility of the medical oncologist.
There must be a partnership in cancer management.
There’s a relationship component to this too. According to a survey done by Cancer Care (2), most patients diagnosed with cancer said they took their oncologist’s recommendations to their PCP, seeking advice on how to proceed. The PCP has the most established trust and influence in a patient’s treatment plan–this is an important insight we shouldn’t ignore–especially when you take into account that poor transitions between PCPs and oncologists can correlate with worse outcomes and lower survival rates (3).
Shared-care or team-based care, where clinicians interact more interdependently and adaptively to achieve common goals, provides more comprehensive and guideline concordant-care for cancer survivors than when followed by oncology teams only (3).
So why are we not communicating more effectively? Why are we not collaborating around our shared goal of achieving better outcomes for our shared patients?
It’s difficult to manage the care of cancer patients as their PCP.
Navigating the cancer care experience to help their patients is not easy on PCPs. They’ve cultivated relationships with their patients over the course of years, and oftentimes, they are the first point of contact for their cancer journey and experience with the medical system. The majority of cancers do not have recommended screening tests and most cancers are not identified through screening routes (5), underscoring the fact that the PCP must be equipped to detect potential cancer in their patients through non-screening pathways. Once the cancer has been identified, then the PCP has to tackle the multiple barriers that exist in getting their patients to the right care, quickly:
The referral process is broken.
In this regard, PCPs often face the same challenges their patients are facing. I can’t tell you how many times in practice physician friends have reached out, trying to get their patient an appointment sooner. It’s crazy how much time and administrative burden falls on the PCP, just to help expedite a referral!
Inconsistent follow-ups and coordination.
I know my PCP colleagues often feel they are on their own when they try to stay “in the loop,” trying to track down either the patient or the oncologist to find out what’s happening. And when they need to intervene, they’re often called too late. Sometimes the patient never follows up with them at all. There are a lot of reasons for this, but at the end of the day, it’s not a failure of people; everyone’s busy. It’s a failure of systems.
Rising cost of oncology.
It’s no secret that oncology is expensive, and costs keep rising. Understanding, supporting and partnering with PCPs is an essential part of fixing how cancer care is delivered within our current healthcare system. We need to collaborate to ensure that correct work-ups have been completed, that patients get into the most appropriate site of service in a timely manner and that end-of-life and palliative discussions are had early.
Collaborative care is essential in bettering the cancer experience for individuals & controlling costs.
At Thyme Care, it’s crucial to our mission that we take every stakeholder in the cancer care continuum into account. We act as the connective tissue between patients, providers and health plans by using effective, timely data, and coordinating communications that can ultimately direct patients to the best care, quickly–reducing the administrative burden that exists for many clinicians today. That’s why looking through the lens of the Primary Care Physician is integral to the work we’re doing and why we’ve brought on Dr. Kevin Fosnocht to lead those efforts as our Vice President of Clinical Network and Strategy. Kevin is a PCP and has held clinical and administrative leadership roles in a complex academic medical center setting, a community hospital health system, and most recently with a population health management company (Tandigm Health). He has led clinical network development and created patient-centered strategies to improve patient and provider experience. Kevin’s deep experience and understanding in both providing value-based care and setting up the systems in place to do so will help us find new ways to improve the cancer experience for patients and their providers.
We’re glad to have him join our team and excited about the opportunity to collaborate closely with primary care providers to improve the cancer experience for their patients.
Sources:
- Impact of Comorbidity on Chemotherapy Use and Outcomes in Solid Tumors: A Systematic Review
- Cancer Care Patient Access & Engagement Report
- Understanding primary care-oncology relationships within a changing healthcare environment
- Improving the Transition From Oncology to Primary Care Teams: A Case for Shared Leadership
- A Proposal to Improve the Early Diagnosis of Symptomatic Cancers in the United States
