COA: Community Oncology Alliance

How are large employers adapting to, and benefiting from, the value-based care practices that are a payer demand and a provider imperative? This was the focus of a panel moderated by Bo Gamble, director of Strategic Practice Initiatives, Community Oncology Alliance (COA), during the 2018 Community Oncology Conference hosted by COA, April 12-13 in National Harbor, Maryland.

A panel of providers discussed key advocacy issues that affect patients and practices and could improve access to care and costs during the 2018 Community Oncology Conference, hosted by the Community Oncology Alliance, April 12-13 in National Harbor, Maryland.

Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders and chair-elect of the American Society of Clinical Oncology’s (ASCO) Clinical Practice Committee, provides a look at legislation to improve patient access to treatments and address drug pricing in cancer care.

There is currently a lack of transparency with pharmacy benefit managers around drug prices and where the rebates for drugs are going, but Congress is pushing for greater transparency that will benefit patients, said Ted Okon, executive director of the Community Oncology Alliance.

How are community practices coping with administering chimeric antigen receptor (CAR)-T treatments? At the 2018 Community Oncology Conference hosted by the Community Oncology Alliance, Houston Holmes, MD, MBA, FACP, Texas Oncology, shared his experience with administering CAR T-cells in a community cancer center–based setting.

The Merit-based Incentive Payment System (MIPS) is a big program designed to be applied to all clinicians, which makes it complex to figure out how to do right, explained Richard Kane, senior director at Avalere.

Typically, cancer pain management is carved out of policies that try to restrict opioid prescribing in an effort to combat the opioid epidemic, but with more and more patients surviving their cancer, there is some uncertainty regarding who is affected by these policies, explained Bob Twillman, PhD, executive director for the Academy of Integrative Pain Management.

Richard Kane and Caroline Pearson, both from Avalere Health, provided oncologists gathered at the 2018 Community Oncology Conference an overview of reimbursement programs offered by CMS and advice on navigating them.

At the 2018 Community Oncology Conference hosted by the Community Oncology Alliance, April 12-13 in National Harbor, Maryland, FDA Commissioner Scott Gottlieb, MD, provided the audience with an overview of current and future plans of the regulatory agency, particularly its strides within the molecular diagnostic testing space.

We want to know all sides of the 2-risk model, like with any challenge or strategy, said Roger Brito, DO, national director for oncology, Aetna.

Before undertaking something like implementing the Oncology Care Model, practices should understand the scope of the project and the overall importance it can have for patient care, said Terrill Jordan, CEO of Regional Cancer Care Associates.

When you have constant evolving contract, there are changes, and so some of the feedback I’m getting is that sometimes it’s hard to keep up with the changes, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Providers should be involved in new reimbursement model development from day 1, said Roger Brito, DO, national director for oncology, Aetna.

When a drug becomes first-line, I would like to think that as a clinician I would have access to that, but most importantly that my patients would not have to have a bake sale or take out a second mortgage on their homes to get therapies that are designed specifically for them, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

Bo Gamble, director of Strategic Practice Initiatives at the Community Oncology Alliance (COA), explains how COA plays a role in supporting practices in preparing for Oncology Care Model.

Over the next years, these spheres (ACOs, primary care, and oncology) that are going on in CMMI need to be coalesced together so that when we have learning collaboratives, not only do we have learning collaboratives within each of these spheres, but we learn from each other in these similar projects, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Aetna is focusing on the healthcare triangle (patients, providers, and payers) and connecting those lines, said Roger Brito, DO, national director for oncology, Aetna.

In order to adapt to the Oncology Care Model (OCM), Regional Cancer Care Associates had to undergo the process of adjusting and customizing its electronic medical records, explained CEO Terrill Jordan.

We should try to remove barriers that are not only in place, but getting higher for clinicians and patients to get evidence-based care, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

The ability to have a plan that’s going to work and be large enough that it makes sense for those involved is a barrier for employers who want to pursue alternative payment models, said David Merrill, HR benefits manager, Volusia County, Florida, and John Robinson, CEBS, REBC, RHU, president and CEO, RobinsonBush.

It’s very unusual to see significant cost savings in the first year of a program; that was true of all the pioneer ACO programs, said Jeff Patton, MD, CEO of Tennessee Oncology.

Involving providers in the development process of new reimbursement models increases the chance that the initiative will be successful and works against caregiver burnout, said Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Don’t underestimate the power that it takes to make sure a value-based program is working, said Sarah Cevallos, chief revenue cycle officer, Florida Cancer Specialists.

The healthcare triangle (patients, payers, and providers) begins with the patient, so we should include the patient in some of the decision-making, said Roger Brito, DO, national director for oncology, Aetna.

The fact that you have certain drugs that treat numerous cancers, and that they may treat 1 cancer different or better than another, would suggest that we should probably have differential pricing models, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

Bo Gamble, director of Strategic Practice Initiatives at the Community Oncology Alliance (COA), believes that broadening communication and education is COA’s main goal in 2018.

Southwest Airlines has set up a split fill program, pharmacy benefit manager, health advocacy program, and a cancer resource guide for employees, said Judy Berger, senior manager, benefits planning, Southwest Airlines.

Year 2 of the Oncology Care Model is about learning from the lessons of year 1 and extending implementation that has already been started, said Terrill Jordan, CEO of Regional Cancer Care Associates.

Until more data is available, it’s difficult for a practice or physician group to make an accurate assessment of whether or not 2-sided risk is appropriate, said Sarah Cevallos, chief revenue cycle officer, Florida Cancer Specialists. Physicians would need to see clear metrics in order to know if they will be achievable.

Based on CMMI's year 1 feedback on OCM, it is clear that a lot of planning is needed and education is crucial, said Terrill Jordan, CEO, of Regional Cancer Care Associates.