How ACCURE Closed Racial Survival Gaps in Cancer — And How CMS PIN Codes Scale It

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You’ve seen the survival gaps. You’ve felt the impact. And the question that follows is both urgent and fair:
What exactly can you do about it — in your clinic, with your patients, right now?

These aren’t theoretical trends. They show up in your consults, your tumor boards, your outcomes.

But here’s what’s rarely said: those numbers aren’t fate. Survival gaps start long before recurrence – with delays, missed steps, and incomplete care. 

That’s what ACCURE (Accountability for Cancer Care through Undoing Racism and Equity) tackled – and closed.

The gaps are structural. And structure can change.

What ACCURE Did – and Why It Worked

ACCURE closed the treatment completion gap between Black and White patients in breast and lung cancer – completely.

How? By doing three things most clinics already have the pieces for:

  • Real-time EMR alerts
  • Trained navigators
  • Transparent dashboards

That’s it.

The results speak for themselves:
Pre-intervention: 79.8% completion (Black patients) vs. 87.3% (White patients)
Post-intervention: 88.4% vs. 89.5% – no significant difference 

This isn’t a theory-of-change. It’s a model that changed outcomes.

Why Now: The Financial Foundation Is Finally Here

For years, equity programs were held back by funding gaps. That changed on January 1, 2024, when CMS launched Principal Illness Navigation (PIN) codes.

  • $79/month for the first 60 minutes of navigation
  • $49 for each additional 30 minutes
  • This translates to ~$8K–$12K/month in reimbursable services per FTE navigator, assuming ~100 patients/month and 90 minutes of average consult.

These codes are permanent, national, and designed to support exactly the kind of navigation ACCURE used to drive equity at scale.

Read more about these codes here.

We now have both the evidence and the economic model to act.

The 3 Levers to Close Survival Gaps

1. Get patients in – and supported
Early screening for financial and social risk. Assign a navigator to close those gaps

2. Get patients guideline care – on time
Use real-time EHR alerts and race-stratified audits to catch missed or delayed steps (This publication shows how)

3. Keep patients engaged – and in trials
Build trust: dedicated interpreters (not family or ad hoc), plain-language materials, opt-out trial screening

The ACCURE Blueprint

Step 1 | Audit Your Baseline

Pull 12 months of patient data: stage at diagnosis, time-to-surgery, time-to-adjuvant therapy, trial offers.
Stratify by race, insurance, and zip code. That’s where disparities surface.

Step 2 | Real-Time Alerts

Set EMR triggers: no surgical consult by day 14, no surgery by day 60–90, trial eligibility gaps.
Refresh daily. Route alerts to navigators.

Step 3 | Navigation

Assign a navigator to every high-risk patient (uninsured, Medicaid, minority, rural).
Bill under G0023, G0024.
Document resolved barriers: transport, childcare, financial strain (ACCC Cancer)

Step 4 | Equity Dashboard

Build a quarterly dashboard of treatment completion and time-to-treatment.
Stratify by race.
Track alert resolution (e.g., % closed in 7 days). Present at tumor board.

Step 5 | Culture Change

Deliver a half-day equity training (e.g., TEAM).
TEAM training has shown significant gains in cultural competency and bias reduction

Step 6 | Fix Trial Inclusion

Make screening opt-out.
Offer travel support, flexible hours, remote consent.
Track trial enrollment vs. clinic population.
(Reminder: Black patients = 12% of the U.S. population, but only 3.1% of trial participants (ASCO))

Ready to Start? Begin With a 2-Minute Self-Audit 🩺

📥 [Download the Equity Self-Audit Tool]

✔ Spot your biggest gap
✔ Commit to one step this month
✔ Track your progress and close the gap within 3 months

The Bottom Line

Survival gaps aren’t immutable. They’re the result of system design.
And design is a choice.

ACCURE didn’t solve the problem with heroic effort — it solved it with structure: visibility, alerts, navigation, and accountability.

We now have the tools. We now have the funding.
The only question is whether we’ll use them.

Warmly,
Shruti

PS: What if equitable care wasn’t a special project — but just standard operating procedure? 

Can you make that real?

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The Compass is your practical briefing on what’s working in oncology care – strategy, science, and systems. No fluff. Just implementation.

Suggested Reads:

1. Development of an Actionable Framework to Address Cancer Care Disparities” (PMC, 2021)

2. Strategies to Advance Equity in Cancer Clinical Trials” (ASCO Educational Book, 2022)

3. 4R Oncology® Actionable Framework” (ACCC, 2024)

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