Partnering to Improve Cancer Prevention, Treatment, & Outcomes - - PowerPoint PPT Presentation

Partnering to Improve Cancer Prevention, Treatment, & Outcomes

Lisa Piercey, MD, MBA, FAAP | February 28, 2020

TDH’s Strategic Plan

PREVENTION

– Engage county health councils to improve local health metrics – Decrease youth obesity – Decrease tobacco use – Decrease substance misuse in high impact areas – ACEs

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TDH’s Strategic Plan

ACCESS

– Optimize internal primary care efficiency

• Reducing wait times
• Streamlining electronic processes
• Enhancing patient satisfaction

– Improve external primary care access – Increase innovation

• Telehealth
• Payment models

– Expand partnerships

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Our Reality = Complexity

So… How are We Doing?

Cancer Trends in Tennessee

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TN Experiences Higher Cancer Rates than U.S.

400 410 420 430 440 450 460 470 480 490 500 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Age-Adjusted Rate per 100,000 United States Tennessee

Source: Tennessee Cancer Registry

Cancer Incidence Rates, All Cancer Sites, Tennessee and the U.S., 2007 - 2016

TN Experiences Higher Cancer Mortality than U.S.

Source: CDC Wonder

Specific Cancers of Concern

Source: Tennessee Vital Statistics

Top Ten Cancers Leading to Death in TN Residents, 2012 – 2016

Cancer type Number

• f Deaths

1 Lung 21,740 2 Colorectal 5,941 3 Female Breast 4,629 4 Pancreatic 4,317 5 Prostate 2,916 6 Liver and Intrahepatic bile duct 2,728 7 Leukemia 2,578 8 Non-Hodgkin Lymphoma 2,318 9 Brain and other nervous system 1,776 10 Esophageal 1,624

Top Ten Cancers Diagnosed in TN Residents, 2012 – 2016

Cancer type Number

• f Cases

1 Lung 29,788 2 Female breast 25,014 3 Prostate 21,109 4 Colorectal 15,493 5 Urinary bladder 7,630 6 Melanoma 7,577 7 Kidney and renal pelvis 7,048 8 Non-Hodkin’s Lymphoma 6,718 9 Oropharyngeal 5,092 10 Leukemia 5,063

General Findings from the Data

• Men in Tennessee experience higher cancer incidence
• Men and black people in Tennessee experience higher

cancer mortality rates

• Despite in-depth investigations, no cancer “hot spots” have

been identified in Tennessee

– (i.e., regions where cancer incidence rates are higher than what is statistically expected)

Disparities by Cancer Type, by Race, TN, 2012-2016

• Note: These disparities highlight a few, but not all of the cancer disparities

by race in the state

• Lung and Bronchus cancer: Black Tennesseans were more likely to be

diagnosed with lung cancer in the late stages than white Tennesseans

– Approximately 16.5% of black lung cancer patients and 19.5% of white lung cancer patients in TN survived 5 years or more after their initial diagnosis

• Prostate cancer: Black men were disproportionately affected by prostate

cancer compared to white men, experiencing:

– An incidence rate over 1.5 times higher than that of white men – A mortality rate over 2.5 times higher than that of white men

Disparities by Cancer Type, by Race, TN, 2012- 2016 (cont’d)

• Female breast cancer: Black women were significantly more likely than

white women to be diagnosed in the late stages among all new female breast cancer cases in TN

– Treatment is less successful in late stages – There were significantly higher breast cancer mortality rates of black women compared to white women in TN

• Colorectal Cancer: Compared to whites, blacks experienced significantly

greater incidence and mortality rates

Rural Areas Tend to Experience Higher Cancer Incidence and Mortality

Source: Tennessee Cancer Registry Tennessee Vital Statistics

Cancer Incidence and Mortality Rates by County, Tennessee, 2012 - 2016

TDH Cancer Services

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TDH’s Cancer Screening Offerings

Available at TDH Primary Care Clinic Sites:

• Breast: Mammogram and clinical breast exam
• Cervical: Pap Smear and HPV testing
• Colon: Hemoccult testing

– Some relationships with providers for colonoscopy

• Prostate: PSA testing with shared decision making

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Breast & Cervical Screening Program

• Provides breast and cervical screening and

diagnostic tests to low income, uninsured Tennesseans (over 11,000 in FY2019)

– Most patients were in urban areas (purple)—

• pportunity for partnership with rural providers!
• Provides patient navigation along the

continuum of care including assistance in enrollment into TennCare for treatment of these cancers

23% 13% 24% 10% 19% 11%

Urban/Rural Status of Resident County TBCSP Patients, Fiscal Year 2019

Large Central Metro Large Fringe metro Medium Metro Small Metro Micropolitan Noncore

In fiscal year 2019, appoximately

• ne-third of TBCSP

patients (N=3.444) resided in non- metropolitan counties.

• Provides community education and outreach
• Assists health systems with the initiation of evidence-based

interventions to increase screening rates

Ways to Engage

Preventing Cancer Risk Factors

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Room for Improvement on TN’s Cancer Risk Factors

Tennessee is consistently higher than the U.S. on:

• Adult Cigarette Smoking
• Adult and Youth Obesity
• Lack of Physical Activity

TDH Cancer Initiatives

• Tennessee Comprehensive Cancer Control Program
• Tobacco control programs
• Physical activity programs
• County Health Council Assessments and Actions

Tennessee Comprehensive Cancer Control Program (TCCCP)

• Cooperative agreement with CDC to support evidence-based interventions from

prevention to palliative care. Covers areas such as:

– Tobacco prevention – HPV vaccination – Exposure to UV light – Radon gas – Excess weight

• Supports the Tennessee Cancer Coalition (TC2), a group of over 100 cancer

stakeholders.

• 2018-2022 Tennessee State Cancer Plan

– Developed by TC2 – Information blueprint for:

• Policy, systems, and environmental changes
• Provider training and professional development
• Patient access, education, and programming

• QuitLine

▫ Free counseling & two-weeks of nicotine- replacement therapy for Tennessee residents ▫ Approximately 30% quit rate at 7-month follow-up

• Baby & Me Tobacco Free

▫ Free counseling and incentive program for pregnant women who use tobacco products ▫ Reduction in low-birthweight births, prenatal complications, and postpartum exposure to secondhand smoke

• Youth Engagement & TNSTRONG

▫ Training youth on peer-to-peer interventions with an emphasis on tobacco products and electronic nicotine delivery systems

TDH Tobacco Control Programs

TDH Physical Activity Programs

• Built Environment Grants

– Small grants for every county – Larger competitive grants ($1.8 M to 35 counties in 2018)

• Project Diabetes

– 35 currently funded projects in 30 counties – Focus on supporting positive policies and environments

• Gold Sneaker

– Recognition program for licensed childcare providers – Providers elect to adopt 7 policies related to physical activity, healthy eating, and tobacco

• Whole Child Initiatives

– Partnership with the Tennessee Department of Education to incorporate evidence on physical activity and nutrition into schools

Tennessee’s County Health Councils

• Established in the 1990’s
• Representative of multiple

sectors within a community

• Exist in all 95 TN counties
• Top resource for improving

population health at the local level

Tennessee’s Community Health Assessments

Review Quantitative & Primary Data

County Health Councils

Identify & Engage Stakeholders Select Priorities & Interventions Implement Action Plan

• 16 counties completed a

pilot CHA process in 2019

• 27 Counties will complete a

CHA in 2020

• Results feed into the TDH

strategic planning process

• Results will drive community

action

• By 2022 all 89 TDH “rural”

counties will complete a CHA

• Opportunities for partnership

exist at every step

Ways to Engage

Promoting Access to Care

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TN State Loan Repayment Program (TSLRP)

• Provides educational loan repayment to qualified primary care practitioners in

exchange for an initial 2-year service obligation to practice primary care in a designated Health Professional Shortage Area (HPSA)

• 65% of practitioners continue practicing in shortage areas for one or more years

after completing their initial service obligation

• As of 2019, mental health providers can apply

Placements by County

J1 Visa Waiver Program 2010-2018

• Provides a Foreign Resident physician with a

waiver of the 2-year requirement to return to their home county to practice medicine.

• Physician practices in a federally designated

shortage area for at least 3 years.

• Up to 30 slots/year (17 currently filled)

J1 Visa Placements (2010-2018)

National Health Service Corps Placements

• 100% federally funded program
• The TDH State Office of Rural

Health assists applicants and provider organizations to apply

All Provider Placements

TDH Funded Healthcare Safety Net Program

1. Local Health Departments providing primary care among core health dept services

– 51 sites

2. Federally Qualified Health Centers (FQHCs)

– 30 entities (3 TDH), operating over 100 clinics – Serve majority uninsured but accept all insurance – Other funding sources include from federal grants and insurance reimbursement

3. Community & Faith Based Clinics (CFB)

– 65+ sites funded by TDH – Funding sources also include donations and grants

4. Dental services

– Often co-located at CFBs

5. Care Coordination

– Project Access in 4 Metro areas

TDH Operating Budget

Safety Net Fund

Receives Funding from:

TDH Supported Safety Net Services

TDH Supported Safety Net Services

TDH Supported Safety Net Services

TDH Supported Safety Net Services

Opportunities for Partnership

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Opportunities for Partnership

• Join the Tennessee Cancer

Coalition

• Improve linkages to care

– Bolster screening and referral connections – Address mortality disparities

• Expansion of Project Access
• Improve provider recruitment

(J-1 Visa and TSLRP programs)

• Prevention

– County Health Councils and County Health Assessments – Promote tobacco prevention and increased physical activity

THANK YOU

M O R G A N . M C D O N A L D @ T N . G O V