On Thursday morning, October 31, 2019, at the Association of Community Cancer Centers 36th National Oncology Conference, Elizabeth Kvale, MD, MPH, Program Leader of Survivorship, Supportive and Palliative Care at LIVESTRONG Cancer Institutes (LCI), gave an in-depth break down of their CaLM— Cancer Life reiMagined— model of cancer care delivery. Dr Kvale’s program was one of the programs honored with an ACCC 2019 Innovator Award.
Dr Kvale said the model is making strides toward “operationalizing patient-centered care, not just talking about it.”
To provide optimal whole-person care, LCI flipped the traditional physician-centric clinic model with an approach that empowers a diverse team of caregivers to serve the mind, body, and spirit of cancer patients, survivors, caregivers, and loved ones.
Oncologists, advance practice providers (APPs), palliative care experts, social workers, therapists, nutritionists, financial navigators, and others work together to prioritize both quality of life (QoL) and optimal disease treatment. LCI’s tailored support services approaches cancer as a chronic condition that requires long-term, whole-person care.
Specifically, she noted, they feel whole-person care should include: access navigation and care coordination; palliative care and symptom management; nutritional support; genetic counseling; integrative therapy like acupuncture and massage; fertility preservation; mental and behavioral health support; spiritual care; financial counseling; job and legal counseling; and fitness/physical therapy/yoga.
The theory behind the CALM model is that “care doesn’t have value unless it is responsive to needs of patients.” In this age of increasingly effective cancer therapies, patients are living longer, and the model of care for this trend must address how patients are now living with or beyond a cancer diagnosis. LCI is very active in getting the community and health systems involved with them and want to ensure a high-level of patient engagement in the model.
The 4 unique identifiers of the CaLM Model are:
- Humanized, personalized, team-based interdisciplinary care
- Patients and survivors as co-creators
- Measuring what matters to patients (Capability, Comfort, Calm)
- Flipped approach: supportive care is the anchor and disease-focused treatment planning and assessment is the plug-in
There are 3 teams at work: (1) the disease team (ie, medical oncologist, surgical oncologists, radiation oncologist); (2) the SWAT team, which is the direct patient interaction team who the patient perceives as their care team (ie, oncology nurse, medical assistant, oncology APP, access coordinator, social worker, palliative APP); and (3) the patient support team (ie, psychiatrist, dietician, genetic counselor, financial navigator, palliative MD, pharmacist, and fertility nurse practitioner).
Chronologically, the model begins when the patient’s initial PRO’s are taken at baseline (eg, depression, anxiety, QoL, trauma, physical symptoms); then there is a whole-person assessment via the SWAT team and multidisciplinary treatment planning; the patient support team is consulted as needed; there is subspecialty oncology clinical assessment and discussion; finally, the whole person care plan is developed and implemented as a team. There is then ongoing assessment and care management.
The program is being implemented incrementally right now, with 242 patients in panel active at this time. It was initiated in late 2018. Their evaluation framework to assess progress and outcomes is a combination of OCM, NCCN, and other established quality measures so they can move into value-based care model over time.
In terms of their outcomes so far, Dr Kvale reported that patients on subsequent visits report trending down scores on second visit, with zero to no symptom burden. Data shows reduced symptom burden over time. Anxiety and depression scores also are decreasing. The ultimate goal is to be able to contract directly with payers and employers and get reimbursed for this model of care, as it delivers a higher level of value.
On the question of whether this model can be scaled to community centers, Dr Kvale said that is a valid question that they are still assessing.—Amanda Del Signore