In a presentation at the 2023 NCCN Annual Conference, Kimberly Bell, RN, MBA, Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic, and Danielle McLaughlin, MPH, University of California San Diego, Moores Cancer Center, highlighted different strategies their centers employ to increase patient access and ensure that patients are seen and treated in a timely manner.

Cleveland Clinic

Bell provided an overview of the Cleveland Clinic’s cancer access model, citing data from 28,000 patient visits and 15,000 new cancer registry patients. She emphasized the importance of considering patient access as a quality metric, as it helps patients reduce their stress and anxiety levels while improving the time it takes to provide treatment.

The Cleveland Clinic has an overall goal of offering an appointment to 100% of patients within 7 days of the patient contacting the clinic. However, their target for achieving success of this goal is 50% due to barriers to care or insurance issues.

In order to meet these goals, the Cleveland Clinic has several initiatives in place. The first initiative is the Cancer Answer Line, a call center that schedules appointments and provides cancer education about treatment types and research to callers. The answer line is operated by two Advanced Practice Providers (APPs) and 10 lay schedulers, with a physician team, disease team lead, social worker, and care coordinator available for support. The staff are responsible for patient registration, retrieving patients’ medical records, and handling insurance approvals.

All of the call center staff must complete extensive training, which includes a 3-month-long orientation and a cancer etiquette class.

“You want someone that has empathy, that’s considerate, and that’s the most important tool that you have when you’re building a call center like this,” said Bell.

During their training, the staff learn the scheduling process, standard operating procedures, and workflows, particularly for the different insurance providers, which are each unique. They also attend monthly meetings with disease programs to further their cancer education and participate in clinical shadowing. The call center team participates in patient huddles twice a week with the revenue cycle team, APPs, and administrators to discuss out-of-network patients and how they can get these patients access authorization within the 7-day goal.

“There are times when we have to understand the ‘why’ because we have to be fiscally responsible as well as watch for the quality and financial toxicity for [the] patient,” added Bell.

The second initiative the Cleveland Clinic uses to support patient access is their in-house database called Cancer Nav. This is a web application that identifies and tracks patients with cancer during their treatment journey and provides reporting and patient tracking tools. These tools help with identifying patient barriers to appointments, scheduling timelines, medicals records, and insurance information.

The Cleveland Clinic’s third access initiative is their sustainability program, which consists of a visual management board that displays the roles and responsibilities of the Cancer Answer Line team. The team manages the board themselves and uses it as a jumping-off point for discussing challenges and finding solutions around patient access. An example of one of the solutions to come from the board discussion is the development of an electronic medical release form, which helps expedite the retrieval of medical records. In addition, as part of the sustainability initiative, the Cancer Care leadership team participates in a War Huddle where they review operating metrics from high to low priority in order to come up with solutions to challenges on the administration end.

Moores Cancer Center

McLaughlin described how the Moores Cancer Center focuses on improvement, intervention, and metrics associated with various points in the access continuum, which is broken down as follows: from the time a referral is received (point of entry), to the appointment scheduled (scheduling), to the date of service (meaningful visit). The center uses the people, technology, and processes framework, relying on the balance of those three elements to reach their access goals. They have two priority goals: the first is the 24-hour metric, which they use to measure the time it takes from when a referral enters their system until it is scheduled. The second goal is to see at least 75% of their new patients in 7 days.

“To effectively manage and improve access, we must constantly be focused on it. We’ve chosen to engrain access metrics, initiatives, and discussions throughout the organization,” said McLaughlin.

McLaughlin noted that one of the center’s greatest strengths is the partnership and buy-in from physicians on the access initiative, including senior physician leaders, designated physician access champions, or disease team leaders.

Similar to Cleveland Clinic, Moores Cancer Center holds weekly leadership huddles, called Access Redesign, where multidisciplinary leadership—including physicians and administrators—meet to review access metrics and discuss priority initiatives.

McLaughlin broke down several initiatives the center developed to streamline patient access at each continuum stage. The point of entry initiatives include:

• New patient coordinator roles
• Referral and work-queue optimization
• 24-hour metric development
• Cisco implementation
• RightFax implementation

For the scheduling stage of the new patient access continuum, McLaughlin said Moores Cancer Center uses templates that are managed centrally with oversight from the physician and operational leaders. Permanent changes to any space utilization, templates, or schedules—or deviations from template standards—must be reviewed by the clinic medical director and the director of patient access and clinical operations with consultation from the division chief and division chief administrator.

To ensure a meaningful new patient visit—the final stage of the access continuum—McLaughlin spoke about the center’s creation of a record collection template designated for each disease team. The center also developed a system for prioritizing “must-have” records versus “nice to have” records for the first visit. They also have a patient navigation program consisting of seven lay navigators that have helped the center reduce no-shows and late cancellations for new patients. Additional technology initiatives to help with patient visits are Well Health appointment reminders and MyPathAPP, which provides patients with important updates related to outpatient oncology. The center has also made a significant effort to expand services to treat patients closer to their homes.

Source:

Bell K, McLaughlin D. New Patient Access Programs. Presented at: 2023 NCCN Annual Conference; Mar 30-Apr 2, 2023; Orlando, Florida, and virtual.