The Important Role of Health Care Alliances in Improving Strategies for Cancer Prevention Protocols

To the Editor:

Community-based health care clinics provide comprehensive primary care as well as behavioral and mental health treatment services. After the recent passage of the Patient Protection and Affordable Care Act (ACA) in 2010, Federally Qualified Health Centers (FQHCs) have become the primary source for health care among the newly insured. To meet the requirements of the ACA, there is a need to address the availability of access to quality care as well as how the coordination of care is being developed. These clinics predominantly serve patient populations who are low income, minority, and uninsured or have significant dependence on public insurance. ¹

Nationwide, these vulnerable populations do not have adequate access to care. The support for improvements in certain areas related to the care they do receive can help direct how improved access and quality care is delivered. Several of those writing on the issue of adequate subspecialty care attribute the lack of consistent quality to the absence of linkage to academic or tertiary care facilities for communication and referrals. ²

This combination of poorly integrated and underserved neighborhoods, limited access to care, and the majority of those patients being uninsured or newly insured and covered under Medicaid magnifies the necessity for intervention. It is especially the case in the context of cancer screening and prevention services that are required under the ACA, but for which referral to specialists is necessary. Addressing issues of referral is important to strengthen the framework for high performance among FQHCs and community cancer care. Formal partnerships with neighboring hospitals and improved communication among providers to facilitate the treatment of their cancer patients have been established as methods to accomplish these goals. ³

Effective therapies developed to treat cancer should be available to all racial and ethnic backgrounds. Yet, these diagnostic and therapeutic algorithms do not eliminate health disparities and contribute to unprecedented health care costs. A benefit of community engagement may be to potentially reduce incidence by fostering risk assessment and earlier detection and diagnosis. At the same time, community health centers enhance the clinical resources and functioning capacity of our health care system. Potential disadvantages include the limited evidence of impact on actually reducing cancer disparities in the outcomes of underserved patients. The sustainability and effectiveness of protocols that are in place to improve health care beyond efficacy also may pose a barrier for clinics to assess.

Clinical outreach programs that are focused primarily on screening and education do not necessarily offer a delivery model that lends itself to better diagnostic services. It is not clear why there is a gap in care, but there certainly is a need to incorporate collaborative care between medical and surgical oncologists and to improve early detection between diagnostic radiologists and primary care providers. The importance of improving patient care through early referral and treatment continuity, managing comorbidities, and supportive discussion is equally necessary. This proposed model of bridging community health care clinics with hospitals shifts the importance within the specialty of oncology to facilitate diagnosis rather than focus on treatment only.