The impact of very early referral on the effectiveness of specialty cancer care management services for oncology patients in active treatment.

Abstract

157 Background: Many patients receiving treatment for cancer experience high levels of morbidity and reduction in quality of life. Proactive specialty cancer care management programs can be offered to patients experiencing these challenges. These patients are most often self-identified, referred by a physician, or identified by claims from a commercial or government insurer or vendor. While earlier intervention of case management or palliative care services has been shown to improve outcomes for cancer patients, a variety of logistic challenges frequently interfere with early referral. Methods: All oncology patients obtaining regimen-based chemotherapy prior authorizations were referred for specialty cancer care management via the prior authorization process. Additionally, all oncology patients in active treatment or with active disease whose benefits included care management were eligible through standard referral mechanisms. Patient satisfaction scores were measured every 3 months for all patients enrolled in the program. The medical cost savings value of referral to the specialty cancer care management program was evaluated by comparing patients referred to the program within 30 days of diagnosis (very early referrals) against patients found between 30 and 120 days from the time of diagnosis. Results: Compared with patients referred through standard methods, patients referred to the specialty cancer care management team at the time of chemotherapy authorization resulted in a high percentage of very early referrals. Patients enrolled in specialty cancer case management within 30 days of diagnosis saved an average of $16,000 per surviving participant, or 30% more than patients referred between 30 and 120 days from diagnosis. Overall, patients engaged in specialty cancer case management are highly satisfied. Overall satisfaction with the nurse/case manager was 98%. Conclusions: Early referral of high risk oncology patients to patient-centered care management programs improves the overall patient experience while simultaneously reducing health care costs, and should be strongly considered for all oncology patients with high morbidity or mortality risk.