Technological advances in cancer care have proven to be beneficial to patients; yet, have caused sky rocketing costs, leading to increasing financial strain for self-funded health plan groups. Third-party cancer risk-management has, therefore, become an essential element in providing effective medical management for self-funded groups. Oncology case management has become a particular challenge for the third-party insurance administrators. 

Our case management team recognized the importance of providing specialty oncology case management, but contracting for the services was not an option. Up to 30% of our case management census is made up of oncology patients, yet only one of our 12 nurse case managers is an oncology specialist. Our case managers were surveyed regarding their knowledge and comfort level related to oncology management. Results clearly showed that the case management team needed education and access to specific oncology tools in order to provide effective specialty oncology case management, and to ensure application of best practices in providing case management services.

To address these needs, management supported our oncology nurse case manager in obtaining an oncology nursing certification, and in development of an oncology resource database. Creating the database involved organizing tools and gathering resource information. The oncology specialist provides training regarding the database, and serves as a resource to the CM team. Education about the needs of oncology patients is provided through in-service presentations, case studies, and the opportunity to attend teleconferences and webinars. The database and tools are used by the case managers during patient assessment, care plan formulation, treatment plan evaluation, and while providing patient education and report writing. Resources are periodically updated to reflect current oncology practices. Specialty resources and training have become essential to our team in providing effective oncology case management.

By tapping into the expertise, passion and experience of our case managers, we have discovered that we are able to provide oncology case management services that are contributing to our client-centered care; and are recognized as a valuable contribution to the success of our company.