Breast cancer is diagnosed in approximately 184,200 women per year and is the second leading cause of death among women. Early detection with timely treatment positively impacts survival rate and lowers the cost of treatment. Cancer management is optimized with rapid navigation and uninterrupted treatment within the three major modalities of breast cancer treatment (surgery, chemotherapy, and radiation therapy). This complex continuum of generally disconnected providers presents significant challenges.
A model of care coordination was developed utilizing a critical pathway with measurable quality indicators to meet the system access and navigation needs of 2,566 underinsured, low-income breast cancer patients in the state of California. This model is differentiated from standard case management within the managed care system. Unlike utilization review, the focus is not financial savings, but life saving. It encourages patient compliance with individualized, but oftentimes complex, care plans involving more than 10 providers; and it prevents breaks in the continuum of treatment. Within this multilevel model, patient care coordination is enabled by the creation of a disease management grid of reimbursement for treatment services. Concurrently, patient education and individualized emotional support were provided in this model. The efficacy of the model in providing timely system navigation, a prevailing theme in cancer management, has been demonstrated through the use of standard quality indicators.
Learning Objectives: 1. Recognize the lifesaving impact of care coordination on the complex, time-sensitive treatment needs of underinsured breast cancer patients. 2. Describe a proven model of patient care coordination. 3. Discuss the measurable elements in a patient care coordination critical pathway from diagnosis to completion of breast cancer treatment.
Keywords: Breast Cancer, Case Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: California Health Collaborative
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employee of California Health Collaborative. The California Breast Cancer Treatment Fund Program is enabled by grants and contracts to California Health Collaborative.