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Using ePROs to Improve Symptom Management and Provide Value-Based Care

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The NCCN 2021 annual conference supported cancer innovation, and multiple speakers were invited with expertise in these areas to discuss timely changes necessary in cancer care, so we can manage patients where they are. Never has there been a greater need for enhanced communication and virtual support than in this year plagued by the COVID-19 pandemic. 

We are making substantial progress in electronic patient reported outcomes (ePROs) and we know they can improve patient time on cancer therapy and overall survival, yet optimizing tool management and implementation remains an area of robust research. Aligning incentives with payers to drive uptake among organizations and utilization by patients are both in early stages. A meeting of the minds at NCCN provided a platform for collaboration between the payer community, the research community, and the care delivery community, to shed insight on how we use these important tools to not just cure cancer, but to help our patients live and thrive where they are. 

Emma Hoo from the Purchaser Business Group on Health (PGBH), an organization that represents payers and employers as they purchase health care to maximize quality and value, discussed her experience with practices that have implemented ePROs over large systems of care to share with us learnings of how PBGH is thinking about improving care with ePROs. Payer and employer groups have historically used Healthcare Effectiveness Data and Information Set measures to benchmark quality. ePROs approach the quality improvement challenge differently by being an interactive tool that patients use, and thus being a patient-centered mechanism to not only measure but also improve the quality of care delivery. PBGH has a grant from CMS and is working with collaborators to grow and develop in this space. 

We discussed optimizing implementation across community oncology practices. I discussed working with Navigating Cancer to implement symptom management tools across the practice. ePROs are a tremendous enhancement for community oncology practices to facilitate real-time communication between the clinical team and the patients we serve. As we have on-boarded our large state-wide oncology clinic on two systems of symptom management this last year, we have learned a lot about optimizing implementation and improving care delivery. Early multi-stakeholder communication is key. Reinforcement by physicians as leaders of the clinical team is necessary. Supporting utilization in patients with physician education is critical. Early evaluation of what is working and what is not through a pilot process can help you identify target areas for education and alteration of your process. Review of tickets and alerts generated, clinical staff feedback, and patient feedback can all help you tailor interventions to improve utilization and timely responsiveness for patients and diminish alert fatigue among the clinical team. The successful implementation of these various tools leads to faster patient responsiveness and avoidance of hospital visits. 

Dr. Paula Polubriaginof from Memorial Sloan Kettering Cancer Center (MSKCC) discussed the development of their own ePRO tool which MSK engages for both research and clinical practice. She discussed the multiple instruments used in the ePRO platform at MSKCC and their experience in using them for more than five years. She also discussed the importance of managing alerts for the patients and the clinical team to make sure the instrument is just right to engage teams as necessary. Dr. Peter Stetson, who leads informatics for MSKCC, facilitated discussion on how we implement these tools and the steps we can take to foster alignment between payers and providers to increase adoption of real-time patient care delivery strategies. 

As a whole, these tools are just one way that we can use clinical informatics tools to improve care delivery to patients where they are. While these tools are proven to be effective mechanisms to manage symptoms, delay response time, increase time on effective therapy, and improve overall survival, we will require organizational prioritization and payer alignment in alternative payment models and management contracts as we move together in the journey toward better value-based care. 

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