health care system and the need for health insurance reforms and innovations in health care delivery.

The Survivorship Committee recognizes that underlying flaws in the organization of health care delivery hamper appropriate survivorship care. The committee endorses the conclusions and recommendations in the IOM report, Crossing the Quality Chasm (IOM, 2001). That report provided the rationale and a strategic direction for redesigning the health care delivery system. It concluded that fundamental reform of health care is needed to ensure that all Americans receive care that is safe, effective, patient centered, timely, efficient, and equitable. To that end, health care organizations need to design and implement more effective organizational support processes to make change in the delivery of care possible. Purchasers, regulators, health professionals, educational institutions, and the Department of Health and Human Services need to create an environment that fosters and rewards improvement by (1) creating an infrastructure to support evidence-based practice, (2) facilitating the use of information technology, (3) aligning payment incentives, and (4) preparing the workforce to better serve patients in a world of expanding knowledge and rapid change.16

Barriers facing cancer survivors and their providers in achieving quality survivorship care include: a fragmented and poorly coordinated cancer care system; the absence of a locus of responsibility for follow-up care; poor mechanisms for communication; a lack of guidance on the specific tests, examinations, and advice that make up survivorship care; inadequate reimbursement from insurers for some aspects of care; and limited experience on how best to deliver care.

Recommendation 5: The Centers for Medicare and Medicaid Services (CMS), National Cancer Institute (NCI), Agency for Healthcare Research and Quality (AHRQ), Department of Veterans Affairs (VA), and other qualified organizations should support demonstration programs to test models of coordinated, interdisciplinary survivorship care in diverse communities and across systems of care.

Several promising models for delivering survivorship care are emerging, including:

  1. A shared-care model in which specialists work collaboratively with primary care providers,


The IOM will be publishing a series of reports starting in late 2005 on performance measures, payment systems, and performance improvement programs.

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