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340B Insight provides members and supporters of 340B Health with timely updates and discussions about the 340B drug pricing program. The podcast helps listeners stay current with and learn more about 340B to help them serve their patients and communities and remain compliant. We publish new episodes twice a month, with news reports and in-depth interviews with leading health care practitioners, policy and legal experts, public policymakers, and our expert staff.
Speaker 1 (00:04):
Welcome to 340B Insight from 340B Health.
David Glendinning (00:13):
Hello from Washington DC and welcome back to 340B Insight, the podcast about the 340B drug pricing program. I'm your host, David Glendinning with 340B Health. We have two guests for this episode, both from UConn Health in Connecticut. Sarah Loschiavo and Ellen Morris-White are both nurse practitioners by training. And in her role as the nursing director of Palliative Medicine, Supportive Care and Hospice Services at Uconn, Sarah runs a cancer Survivorship program at the health center that is funded in part because of 340B.
(00:50)
Ellen is one of the members of the clinical team that sees patients who sign up for that program. We wanted to speak with both of these professionals to learn more about how 340B is helping cancer patients well after they have finished their curative treatments. Here's that conversation. I am here with Sarah Loschiavo and Ellen Morris-White, who are both from UConn Health based in Farmington, Connecticut. Sarah and Ellen, I am looking forward to our discussion today. Welcome to 340B Insight.
Sarah Loschiavo (01:22):
We're happy to be here. Thanks for having us.
Ellen Morris-White (01:24):
Thank you.
David Glendinning (01:26):
We are here today to speak about what I find very interesting and innovative 340B funded program you have at your health system, but we want to set the stage a little bit here first. So Sarah, please tell us a little bit about UConn Health and John Dempsey Hospital.
Sarah Loschiavo (01:43):
This is a health system for the University of Connecticut and home to the UConn Medical and Dental schools. We also have affiliations with the UConn School of Nursing and some allied health services. The primary location is John Dempsey Hospital, which is a teaching hospital on the main campus in Farmington. It's actually the only public academic medical center in Connecticut and it also serves as a safety net provider with the [inaudible 00:02:10] Emergency Department in Farmington and an advanced stroke center.
David Glendinning (02:14):
So it sounds like you're a significant source of care for patients there in I guess what we'd call a central Connecticut. What are the ways in which 340B supports UConn Health at the main campus?
Sarah Loschiavo (02:27):
John Dempsey Hospital qualifies for 340B as a disproportionate share hospital, which really just says that we have a large population of low income patients. The amount of our annual 340B savings is less than the uncompensated care we provide in a year. We also provide direct patient assistance via drug cost assistance with a pharmacy liaison services.
(02:52)
We also improve our health outcomes and access through our medication therapy management program and our extensive nurse navigation program, which really helps to guide patients to cover barriers that they may be encountering with any part of their care here at UConn, whether it's in the cancer center or outside that with our population health. And we also support the NEA Cancer Center through high-risk programs in our Survivorship program.
David Glendinning (03:20):
It is that cancer center and specifically the Survivorship program that we are discussing today. How did this Survivorship program come about at UConn?
Sarah Loschiavo (03:30):
Well, it's been really exciting. Survivorship care has always been a part of comprehensive cancer care, but we really lacked evidence-based models. And so many of our accrediting bodies and best practice models in the recent years have been kind of shining a light on the importance of Survivorship care and we have the opportunity here at UConn to kind of gather our resources and really create not just a checking the box program for our patients, but really a comprehensive interdisciplinary model of care.
(04:06)
There's actually no best practices that exist because every hospital system functions very differently in terms of their resources, what they can provide to patients and really their bandwidth, although there are parts of Survivorship that there's an accreditation piece linked to. So here at UConn, we've been supported in making sure that we build and sustain a program that is interdisciplinary and really puts the patient and family priorities upfront.
(04:35)
We don't have a standalone cancer center, but we designed really a progressive model based on our patient's needs, which is actually an embedded program here, and it's actually run by palliative care nurse practitioners who really have a keen training and focus on what are the unique needs of our patients and how can we meet the physical, spiritual, emotional psychosocial needs the day they become a survivor at diagnosis through the course of their journey.
(05:05)
Our model is an interdisciplinary model led by advanced practice nurse practitioners. We also have an oncology social worker, a physical therapist trained in oncology and a registered dietician. We work closely with other partners here at UConn Health, whether it's our health psychologist, health psychiatrist, other support services that we can make sure that we provide to patients.
David Glendinning (05:26):
Ellen, I know you're one of the nurse practitioners that are on more the clinical side of this that make this program possible for patients, so let's focus on those patients for a minute. What types of individuals do you see through this program and how do you connect to them?
Ellen Morris-White (05:44):
Well, the program supports patients who have met criteria by completing a curative course of cancer treatment. Eligible patients are identified by the nurse navigator that's been with them from the beginning of cancer journey and their initial diagnosis and throughout treatment. Those patients are notified by their primary oncology team that the Survivorship care program exists and that they're eligible for it.
(06:09)
And a patient interested in the program is referred to our clinic, or if they decide they're not going to pursue it, we send them a package of information that includes their Survivorship care plan, a cancer Survivorship information guide, and then any contact info if they'd like to change their mind and come into the clinic. Most Survivorship visits are done three to six months following their completion of treatment.
David Glendinning (06:35):
Okay. Three to six months after that curative treatment is done, so hopefully they are on the pathway to better health. Why do you establish that window? Why is it important for you to connect with patients at this particular point in their recovery?
Ellen Morris-White (06:51):
Well, at this point they have been cleared and their cancer is cured and or controlled. In some cases, patients are still receiving some type of hormone therapy specifically for say, breast cancer patients, but they're eligible to receive these services and they're at a point in their lives where we really want to focus on supporting them going forward. The programs to help patients locate any expert care that they might need, any education resources and support using this interdisciplinary model to help them understand what to expect in cancer Survivorship and how to manage any issues related to living their life after cancer.
David Glendinning (07:32):
Okay. And I know Sarah had said earlier, she mentioned some of the elements to that, the physical side of things, the psychosocial side, the financial side. Certainly a lot to think about and potentially a lot to worry about for patients in these families. So Ellen, how does the Survivorship program aim to help patients tackle these challenges?
Ellen Morris-White (07:53):
Well, we focus on primarily evaluation and education. We want them to better understand their short-term and long-term side effect potentials from treatment, help them lower any risks for secondary cancers, and then we address any concerns that are voiced during that encounter that are maybe physical, psychosocial, financial concerns that they may have that were not addressed during their treatment journey, primarily because that focus was on getting through treatment.
(08:22)
Now that they're a survivor, we need to help them move forward and in a very focused and health-based way. Patients receive something called a Survivorship care plan that includes the background or the history of their cancer journey from the beginning of their diagnosis, any imaging, any labs, any pathology results that explain their diagnosis and the treatment plan, the specifics of that, maybe chemotherapy, radiation therapy, other forms of treatment that help to control the disease.
(08:57)
We also include in that what steps they need to follow in order to have ongoing monitoring or surveillance and any additional screenings to maintain their overall health. During these individual encounters that patients have with each of our specialists, referrals, both internal or external are generated to connect that patient with the appropriate resource for them to be able to address that concern.
(09:27)
For example, if they meet with a physical therapist and they have issues with swelling or muscle soreness or exercise endurance, then they're referred to a specialist in rehabilitation to support that need. If they have financial challenges after their cancer journey is complete, that encounter with the social worker, the oncology social worker will help connect them with community resources or funding to support needs that they have.
(09:54)
For example, we utilize the Dispensaries of Hope program at UConn to connect patients who are low income or in need and they have other health issues unrelated to their cancer diagnosis, maybe with chronic health issues, and they can't afford medications to control that condition. From a dietary perspective, the nutritionists will meet with them and address any weight issues, either weight loss from treatment or weight gain, and will connect them with a resource in the nutrition department or external services to help with those related issues.
(10:32)
When I see them, we review any side effects or symptoms that they're having that are short-term, potentially long-term effects, and how to deal with them and connect them with resources for shortness of breath or other issues related to their recovery. In addition to that, I will connect them with resources for screenings for any cancer risks that they have going forward, like a colonoscopy or a bone density screening or other screenings that help keep them healthy and cancer-free going forward.
David Glendinning (11:04):
And Sarah, that sounds really significant to me. From what Ellen is saying, it sounds like there are significant resources involved with providing this care and support. What about the costs associated with providing these Survivorship services?
Sarah Loschiavo (11:18):
Yeah, great point. So the costs are covered by our health system, including the help of 340B funding. Our low-income patients can receive financial assistance for ongoing cancer therapies, and over time, the program is really expected to decrease cost from recurrence and re-hospitalizations. Our patients really don't know that these programs are supported. They just know that the funds are there and their focus is really on getting the care that they need to continue to remain healthy and live productive and active lives.
David Glendinning (11:50):
It's so interesting to hear you say that because it's a bit of a theme we hear when it comes to 340B funded care programs. Patients rarely know what 340B is or how it works, they just know that the care is there for them and it's taken care of. I'm thinking about some best practices here. Sarah, what can other 340B hospitals or non-340B hospitals for that matter, learn from your example here?
Sarah Loschiavo (12:14):
So as we discussed a little bit earlier, their evidence is really lacking on Survivorship care models, but we have really worked within our own institution to provide at least a best practice model that could possibly be applied in some form or fashion at any institution, whether it's an academic or not. We actually published a research study in the Journal of Oncology, Navigation and Survivorship entitled "Designing, Implementing and Evaluating an Interprofessional Survivorship Model of Care in an Academic Medical Center."
(12:48)
In this research, we really just highlighted the program we've built here at UConn and how this interdisciplinary model can support our oncology team and our institution and obviously patients and families first. Because that's really the need. We really wanted to meet that gap and really go beyond in checking the boxes and making sure that patients are front and center to this and they're getting the most benefit out of this program.
(13:17)
And in our research, we found that this nurse practitioner led interdisciplinary model can really work to meet these accreditation standards in all the needs of patients, right? Because, and patient needs may change over time. Coming right out of Survivorship, they may have certain needs that they want to addressed quickly, and as the years continue on during Survivorship, their needs may change.
(13:41)
And so we really kind of start the conversation about that and how do they prioritize needs and get them the resources and the education two, three, five years, 10 years down the line if things come up. How do they access that information and resources so they continue on their wellness journey? There's really no one size fits all approach because every hospital and institution is very different, but we've been able to at least provide that foundation that hospitals or cancer centers can use to at least see if something like our model here at UConn works for their patient population.
David Glendinning (14:19):
Well, we will be sure to include a link in the show notes to that research so that other hospitals can see all the great work you've done and perhaps get inspired to do their own. Ellen, I want to make sure I get back to you to hear a bit more about the end user of all this, which is the patient. How have patients responded to the Survivorship program that you've provided them?
Ellen Morris-White (14:41):
The feedback so far has been excellent. Patients are not made aware of the program until again, they've completed treatment and they're on surveillance. And at times, one of the common feedbacks from the patients has been that they were not aware of these services and sort of wish that they had known about them earlier on in their journey. Patients going into Survivorship can sometimes have some disconcerting type of sensation. They feel a little left behind.
(15:10)
They're not as closely monitored as they were during treatment. And so having this encounter reconnects them with their support team in a more focused way for again, moving forward with their life after cancer. When we do these visits, they're learning about services that maybe they didn't know was there before.
(15:30)
Those services help the patient, their caregivers, sometimes other providers. And at times, we're really focusing on their overall experience and not just specific health needs. Having a standalone clinic helps them to reconnect, but also to help them feel like they are empowered to move forward. I don't think that there's any other program in this area that is unique in that way.
David Glendinning (15:56):
Do you have a patient story or perhaps an example of a type of patient helped by this program?
Ellen Morris-White (16:03):
I had a patient who was a middle-aged man of Hispanic origin, had very poor English skills at his diagnosis, and so he struggled with information and communication during his treatment plan, and he had some issues with trusting that oncology team. However, he went through everything. He was able to complete his treatment and his cancer was cured.
(16:29)
He was referred to Survivorship at the six-month mark after his imaging indicated that his cancer was gone, which is the key indicator of it's time for Survivorship. We brought in an on-site interpreter for him, and we were able to use our interdisciplinary team really effectively for him. And during that process, we were able to identify physical, social and financial needs that he had. He was struggling with something called lymphedema.
(16:58)
The physical therapist on our team evaluated him, gave him some educational and literally exercise instructions in that room, in that experience using the interpreter, and he was able to demonstrate back, and then we referred him to an outpatient lymphedema therapy service for long-term therapy and follow-up. The nutritionist met with him and he was struggling with regaining his weight. She put together some information again in English and Spanish and some meal plan recommendations that he was able to use, and he was referred to a nutritional specialist who was also bilingual.
(17:34)
I met with him and because of his age, referred him to a primary care clinic for ongoing health maintenance, and I sent him for GI screening for colon cancer and a dermatologist for what we call total body skin checks to rule out any skin malignancy risk. He met with a social worker and was talking about his income issues, and again, we sent him to our Dispensaries of Hope so he could get medication to manage these other health issues that he has. He called me a couple of months after this encounter through the interpreter line and wanted to tell me how grateful he was for what we did for him.
(18:15)
He had his colonoscopy, they removed some precancerous polyps, which again helped him from developing a secondary cancer, and he said he's been trying to educate his family and peers and friends that still don't get screened, still don't get testing done, and educate them on how important this is. He told me that he was moving to New Jersey where his niece was. So his Survivorship care plan that was in English and Spanish when we printed it out was really helpful for him to establish new care in a different state.
David Glendinning (18:53):
What a wonderful story. It's so nice to hear you were there for that patient and for all the others. Sarah and Ellen, I am very glad we got the chance to be here today to speak about the UConn Cancer Survivorship program. We always appreciate the chance to showcase how our member hospitals are using their 340B funds in innovative ways, so thank you both so much for helping us do that.
Ellen Morris-White (19:18):
Thank you.
Sarah Loschiavo (19:18):
Thanks for having us.
David Glendinning (19:20):
Our thanks again to Sarah Loschiavo and Ellen Morris-White. It's so interesting to hear how 340B is touching patients' lives well after they leave the hospital treatment setting and are on the road to better health. We appreciate all the nurse practitioners and other professionals who are instrumental in making that happen.
(19:40)
Be sure to check out the show notes to read more about UConn's work in this crucial area and the best practices they have to offer other health systems. How does your health system use 340B savings in innovative ways? We're always looking for the next innovation to share with our audience. You can contact us at podcast@340Bhealth.org to share. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Speaker 1 (20:14):
Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340Bpodcast.org. You can also follow us on Twitter at 340B Health, and submit a question or idea to the show by emailing us at podcast@340Bhealth.org.
Speaker 5 (20:35):
Voxtopica.