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Review
. 2017 Aug 22;1(19):1617-1627.
doi: 10.1182/bloodadvances.2017008789.

Patient-centered care coordination in hematopoietic cell transplantation

Nandita Khera  1 , Patricia Martin  2 , Kristen Edsall  3 , Anthony Bonagura  4 , Linda J Burns  5 , Mark Juckett  6 , Olivia King  5 , C Frederick LeMaistre  7 , Navneet S Majhail  8
Affiliations
Review

Patient-centered care coordination in hematopoietic cell transplantation

Nandita Khera et al. Blood Adv. .

Abstract

Hematopoietic cell transplantation (HCT) is an expensive, resource-intensive, and medically complicated modality for treatment of many hematologic disorders. A well-defined care coordination model through the continuum can help improve health care delivery for this high-cost, high-risk medical technology. In addition to the patients and their families, key stakeholders include not only the transplantation physicians and care teams (including subspecialists), but also hematologists/oncologists in private and academic-affiliated practices. Initial diagnosis and care, education regarding treatment options including HCT, timely referral to the transplantation center, and management of relapse and late medical or psychosocial complications after HCT are areas where the referring hematologists/oncologists play a significant role. Payers and advocacy and community organizations are additional stakeholders in this complex care continuum. In this article, we describe a care coordination framework for patients treated with HCT within the context of coordination issues in care delivery and stakeholders involved. We outline the challenges in implementing such a model and describe a simplified approach at the level of the individual practice or center. This article also highlights ongoing efforts from physicians, medical directors, payer representatives, and patient advocates to help raise awareness of and develop access to adequate tools and resources for the oncology community to deliver well-coordinated care to patients treated with HCT. Lastly, we set the stage for policy changes around appropriate reimbursement to cover all aspects of care coordination and generate successful buy-in from all stakeholders.

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Conflict of interest statement

Conflict-of-interest disclosure: P.M., A.B., and C.F.L. are employed by for-profit companies (Anthem Inc., Optum, and HCA-Sarah Cannon, respectively) and hold stock/ownership interests. The remaining authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Phases in the HCT continuum and involvement of main stakeholders. Follow-up care can take place at the transplantation center for a few patients, but most other patients return to their referring hematology/oncology providers. LTFU, long-term follow-up; PCP, primary care provider.
Figure 2.
Figure 2.
Issues and stakeholders in care coordination. Evaluation (A), pretransplantation (B), transplantation event (C), and follow-up care (D). AD, administrator; C, consulting; CC, care coordinator; CG, caregiver; CP, consulting provider; GVHD, graft-versus-host disease; Hem/Onc, hematologist/oncologist; I, informed; P, payer; PCM, payer case manager; Pt, patient; R, responsible; SSI, supplemental security income; SW, social worker; TC, transplant center; TFC, transplantation financial coordinator; TP, transplantation physician.
Figure 2.
Figure 2.
Issues and stakeholders in care coordination. Evaluation (A), pretransplantation (B), transplantation event (C), and follow-up care (D). AD, administrator; C, consulting; CC, care coordinator; CG, caregiver; CP, consulting provider; GVHD, graft-versus-host disease; Hem/Onc, hematologist/oncologist; I, informed; P, payer; PCM, payer case manager; Pt, patient; R, responsible; SSI, supplemental security income; SW, social worker; TC, transplant center; TFC, transplantation financial coordinator; TP, transplantation physician.
Figure 2.
Figure 2.
Issues and stakeholders in care coordination. Evaluation (A), pretransplantation (B), transplantation event (C), and follow-up care (D). AD, administrator; C, consulting; CC, care coordinator; CG, caregiver; CP, consulting provider; GVHD, graft-versus-host disease; Hem/Onc, hematologist/oncologist; I, informed; P, payer; PCM, payer case manager; Pt, patient; R, responsible; SSI, supplemental security income; SW, social worker; TC, transplant center; TFC, transplantation financial coordinator; TP, transplantation physician.
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References

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