Breaking Down Silos in Oncology Care: Enhancing Communication and Education for Improved Patient Outcomes

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There is a critical need to break down silos in health care to improve patient outcomes, Michael Reff, MBA, RPh, founder and executive director of National Community Oncology Dispensing Association (NCODA), explained during a panel discussion at Asembia’s AXS24 Summit in Las Vegas, Nevada. To accomplish this, panelist Stacey McCullough, PharmD, chief pharmacy officer (CPO) of NCODA, explained that one step may be sharing a common vernacular rather than relying on siloed terminology that is specific to the specialty of each health care professional (HCP).¹

“When you have different specialties, everybody has their own vernacular,” McCullough said during the session. “So establishing common terminology is important.”

Additionally, McCullough explained that innovation in oncology can also create silos because there can be numerous stakeholders involved, which can lead to fragmentation. For this reason, communication and shared terminology among all stakeholders are crucial so the patient hears the same information about therapies and services being used in their care from each HCP they meet with on their care journey.

Furthermore, McCullough noted in an interview with Pharmacy Times that a lot of information can be thrown at patients when they initially start their oncology care journey. For this reason, there is a need for the whole team—including physicians, pharmacists, and advanced practice providers (APPs)—to continue the same story and give the same information from the initiation of care. McCullough noted that NCODA provides education sheets for all HCPs for this purpose.

“If all [HCPs] looked at the education sheets, maybe that would be something that would make it consistent for the patient so that [they are] not potentially getting conflicting information,” McCullough said during the interview. “We’re simplifying the information that [the patient] is getting [in these sheets].”

McCullough explained further that communication with the patient from each care team member about their care and treatment should also be noted in the electronic medical record (EMR). If this communication is absent from the EMR, this can create an additional disconnect among HCPs who are providing care for a patient.

“It [should] all [be] in the EMR,” McCullough said in the interview. “The pharmacist works with APPs, and everything they do and all the contact they have with the patient throughout their therapy [should be] put into the EMR.”

McCullough explained that the fulcrum of medically integrated care can be found in the action of the pharmacist and whether there is communication between the pharmacist and other members of the patient’s care team. When such communication between the pharmacist and other care team members occurs, that should also be noted in the EMR, according to McCullough. “All [communication should be] documented in the EMR so that [all HCPs know] exactly what’s going on with that patient,” McCullough said.

Panelist Neal Dave, PharmD, executive director of Pharmacy Operations at Texas Oncology, explained that at Texas Oncology, there are approximately 350 medical oncologists, 600 physicians, and 300 APPs, with silos across the board. “We have 45 pharmacies that are on-site and integrated with the clinic, and that’s how we’re addressing [these silos], at least internally,” Dave said during the session. “Our physicians, our APPs, pharmacists, and nurses [are] all in 1 place, in 1 facility, and pharmacists are right there at the point of care. So patients are able to come into the clinic, see the doctor, pick up the medications, and go home.”

According to Dave, access to medications is one of the biggest barriers for patients, acting as a sign of the presence of siloed oncology care. Furthermore, the inability to provide patients with choices for medications at the clinic as new therapies become available can be another aspect of siloed care.

“That’s an area where silos have grown because of the patient choice issue: the affordability of medications,” Dave said. “They’re getting more and more expensive. So again, you’re limiting access for patients, [who will have to] work hard to find a way to access their drugs and afford their drugs.”

According to Reff during an interview with Pharmacy Times, access and affordability of medications can help ensure a patient will stay on at the cancer center for as long as possible. “That’s what quality, coordinated care is all about,” Reff said. “That continuity of care is the underpinning of medically integrated oncology practice, whether you’re at [a large cancer center] or in the community setting.”

Another area where siloed care can become more visible is in the approval process for a patient to start a medication, according to Dave. “Right now, we [conduct] precision health testing [and] broad panel testing, and you have to get prior authorization for that. If you have a mutation that’s actionable, you have to get a prior authorization for the drug. Every step of the way, there are scans or tests that need to be done, and even though it’s the same insurance company [and] the same diagnosis code…you’re still having to jump through hoops. And all these situations should all be connected,” Dave said. “So there’s a communication barrier internally within the prior authorization process and even between where you get your scan and where you get your drugs from. I think those are some of the biggest challenges we’ve seen.”

Panelist Scott Freeswick, PharmD, MS, Vice president and CPO at Memorial Sloan Kettering (MSK) Cancer Center in New York, New York, explained that the challenges related to siloed care at Texas Oncology noted by Dave are similar to those at MSK Cancer Center. As one of the largest cancer centers in the country, MSK Cancer Center has 14 buildings with 18 pharmacies. Thousands of patients are cared for in this cancer center every day, with approximately 300,000 chemotherapy doses given every year, according to Freeswick.

“All the challenges that Neil pointed out are the same. At our specialty pharmacy, unlike what Neil was describing, we have 1 centralized pharmacy, and what we do is carry the medication either to the clinic where the patient will pick it up, or the patient can get it at home. But the prior authorizations are a big pain point for us, [because we need to make] sure these patients get their drugs on time, whether it’s an infusion therapy scheduled in the clinic or a take-home medication,” Freeswick said. “There are so many challenges. We try to keep the care within MSK, but if a patient’s forced to go off-site for care, then those silos start happening. The patient unfortunately suffers [as a result], and there may often be a delay in care as well.”

Freeswick noted that coordinated, tailored education for each patient can be crucial to make sure that patients aren’t confused by the information they are receiving from each HCP they meet with on their care journey. Notably, just as a patient can be undereducated on their care and treatment, they can also be overeducated as well, which can lead to confusion for the patient, according to Freeswick.

“We work together with the care team to not overeducate,” Freeswick said. “Having all that [information] together in 1 coordinated education [session] for a patient [can help].”

Ultimately, McCullough noted that coordinating education efforts/process is a key component of effectively addressing silos among HCPs as well as keeping communication consistent and clear for patients. Specifically, coordinated, tailored education can help drive oncology care quality. Education sheets, such as those provided by NCODA on their website, can be used by all HCPs, including physicians, to make sure that education is consistent and clear.

“If the physician is an educator, they can pull up that sheet. If the APP wants to educate, maybe they could use the same sheet,” McCullough said. “In the end, the patient has 1 resource that they’re referencing and not a lot of similar but potentially different information they’re receiving.”

Reference

Reff M, McCullough S, Freeswick S, Dave N. Beyond silos: how an integrated care team elevates patient care. Presented at: AXS24 Summit; April 28-May 2, 2024; Las Vegas, NV.