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A Stanford expert describes ideal treatment locations, common barriers, and how payers could better support patients and families.
Rajni Agarwal, MD, a pediatric oncologist at Stanford University Medical Center’s Lucille Packard Children’s Hospital, says that the Centers of Excellence model is the best approach for the treatment of pediatric cancers. That’s because patients-and their families-need an interdisciplinary approach to care, one that takes into account the clinical needs of patients, and the sociological and psychological needs of the entire family.
Managed Healthcare Executive (MHE) recently interviewed Agarwal, an expert on bone marrow transplants for pediatric cancer, on the benefits of the Centers of Excellence treatment model when caring for children with cancer.
Agarwal: First, it means the medical center has providers with the appropriate training and experience in that field of treatment. Second, it’s equipped to deal with a particular patient type. For example, not everyone can do bone marrow transplants. You have to have a specific infrastructure to carry out this procedure for the best outcomes.
Third, you have to have really excellent cell-processing and cell-collection facilities and experience doing both. Fourth, you have to have designated sub-specialties, because these patients are complex.
Fifth, providers at the facility really need to treat enough of these patients on an ongoing basis. That means they keep all these skills up.
Agarwal: The expertise needed to treat pediatric cancers should be concentrated in one place.
If you designate Centers of Excellence, these are the facilities that have the ability-because they have all five features mentioned in my response to your first question-to follow the appropriate treatment protocols.
Agarwal: This is a multidisciplinary approach, which means you need doctors, nurses, infusion centers, pharmacists, psychologists, and social services. Basically, all of this has to be holistic, because you’re treating the child who has cancer with medicines, but that’s only one part of taking care of these children. There are so many facets that you have to take care of.
Agarwal: You need sociologists and psychologists, in particular, for pediatrics, because there are parents and siblings-and they all need attending to.
One scenario is with a child who has two siblings and two parents. Both parents work, and the child has cancer. The family functions quite well together. Because the child is young and so frightened, one of the parents needs to be with him. The other parent has to work to keep their health insurance. Child care also becomes a big issue, and the other children’s needs are also important; you need to think about who will attend to their needs.
Then take another family, at the other end of the spectrum. Maybe one of the parents is a drug user or has a mental illness, and there are very poor supports for the family. This family also includes two children, in addition to the child who was diagnosed with cancer. Caring for this family is that much more difficult.
Agarwal: I would ask that payers not ask for authorization for every single treatment the patient will need over the course of their treatment. That creates delays, wastes resources, and causes anxiety to the parents. And it also makes providers feel like they can’t provide the type of treatment they want to provide to their patients.
As a provider, I think I should give payers a roadmap for the care I want to provide to my patient. I need to say, “Ok, this is a patient with leukemia. The treatment is going to go on for two years. And on broad stroke, this is what the child is going to need: A bone marrow transplant, imaging, and blood tests.”
That means I won’t have to get a re-authorization each time I want to provide a particular treatment to my patient.
Agarwal: Here’s an example of why it’s important: I give my patients a drug called IVIG [intravenous immunoglobulin], which helps fight off infections. If I tell the payer in advance that I want to use IVIG, that means I won’t be put on hold every four weeks to get approval of this treatment renewed; this takes so much time, and often the treatment gets delayed.
When my patients take IVIG, it reduces their chances of getting an infection, which means they spend less time getting admitted or re-admitted to the hospital-and that means lower costs for the payer.