Currently Viewing:
COA Community Oncology Conference 2019
Currently Reading
COA Close to Filing OCM 2.0 for Federal Review
April 05, 2019
Katie Goodman: Bring Clinical Trials to the Community Setting to Meet Patients Where They Are
April 05, 2019
Dr Howard Burris on Efforts Needed to Ensure Access to NGS Testing
April 05, 2019
Dr Lee Schwartzberg Explains the Promise of Liquid Biopsies in Cancer
April 06, 2019
Dr C.K. Wang Discusses How Real-World Data Can Benefit Payers
April 06, 2019
Pharma Discusses How to Reframe Value in Era of Precision Medicine, Combinations
April 06, 2019
Step Therapy in Medicare Advantage Hurts Patients, Providers, Says Schwartzberg
April 06, 2019
Dr Basit Chaudhry Outlines Findings From OCM PP3
April 07, 2019
Dr Jeffrey Scott on Pharma's Role in Understanding the Value of Novel, Expensive Therapies
April 07, 2019
Dr Jeff Patton on OCM PP3 Results, Challenges With the Model
April 09, 2019
Dr Sonia T. Oskouei Discusses Uptake, Cost Savings With Filgrastim Biosimilar Xarzio
April 11, 2019
Katie Goodman on FDA's Efforts to Expand Patient Inclusion Criteria for Clinical Trials
April 11, 2019
Dr Lee Schwartzberg Reflects on the Approval of the First Immunotherapy Regimen in Breast Cancer
April 12, 2019
Dr C.K. Wang on How Real-World Data Provide a More Comprehensive Picture of Drug Efficacy
April 14, 2019
Dr Basit Chaudhry on Challenges With Improving Performance Under OCM
April 17, 2019
Dr Jeff Patton Explains How Physician Shortage, Burnout Are Impacting Community Oncologists
April 22, 2019
Dr Lee Schwartzberg on Genetic Testing for All Patients Diagnosed With Breast Cancer
April 23, 2019
Dr Sonia Oskouei Explains the Importance of Education Around Biosimilars
April 24, 2019
Katie Goodman Discusses Clinical Trial Participation Criteria's Impact on Trial Participation
April 25, 2019
Dr C.K. Wang: How COTA's Real-World Data Platform Helps Oncologists Make Informed Decisions
April 27, 2019
What Dr Howard Burris Will Focus on as ASCO President
April 28, 2019
Dr Basit Chaudhry: Evaluating the Adequacy of Novel Therapy Adjustment Under OCM
April 29, 2019
Dr Lee Schwartzberg Outlines Challenges With Accessing Multigene Testing in the Community Setting
May 07, 2019
Dr Jeff Patton Discusses CMS' Proposal to Ease Protections on 6 Drug Classes in Part D
May 08, 2019

Strategies for Fighting Consolidation in Community Oncology

Mary Caffrey
At the Community Oncology Alliance's 2019 Community Oncology Conference in Orlando, Florida, a panel discussed strategies for practices to collaborate and survive the recent wave of consolidation. Targeting employers is one solution.
The grim data in the 2018 Community Oncology Alliance (COA) practice impact report tell the story: since 2008, a total of 1653 practices have closed, been acquired by hospitals, or are struggling financially. This continues, COA says, despite the fact that cancer care delivered in the community setting is less expensive than that in a hospital.

How can community oncology practices fight back?

“We need different solutions for the market today,” said Jeffrey Patton, MD, the chief executive officer of Tennessee Oncology, as he started the discussion late Thursday at COA’s 2019 Community Oncology Conference in Orlando, Florida.

Patton, 3 other oncologists, and a pharmacist shared ideas on how collaboration is the key to survival, as academic medical centers and large hospital systems encroach on turf that was once the domain of community oncology.

Edward Licitra, MD, PhD, the chief financial officer and director of revenue cycle of the central New Jersey division of Regional Cancer Care Associates (RCCA), described the battle for market share in the state, where Penn Medicine has affiliated with a health system as far north as Princeton, New Jersey, and a large cancer hospital affiliated with a new medical school in Camden now carries the MD Anderson brand.

The wave of “vertical integration” is different from prior rounds of consolidation, Licitra said. “Community oncology is a tremendous value for all the reasons that we know,” he said. “It has not even tapped its full potential” from a contracting perspective or a translational scientific perspective.

“In order for us to survive, we need to figure out how the right people can come together, to leverage the scale and also leverage the expertise,” Licitra said. “If we don’t do that, there is very little chance that we will be able to survive.”

Sibel Blau, MD, medical director of Northwest Medical Specialties, PLLC, said that community oncology is essential in helping the country hold down healthcare costs. But practices have to work together, because individually, “we don’t have enough of a voice,” she said. “Now, we’re getting together and doing this.”

Her practice joined a “supergroup” that converted to a clinically integrated network (CIN), which she said allows the practices to maintain its independence while sharing ideas and expertise and purchasing clout. As a group, the CIN practices have a stronger seat at the table with payers.

For too long, Blau said, physicians let others take care of business. “We let big companies, with big influence, take advantage of us,” she said. By creating models like the CIN, Blau said, community oncology can fight vertical integration.

Blau agreed with panelist Steven D’Amato, BScPharm, executive director of New England Cancer Specialists in Maine, that collaborations can take many different forms. While New Jersey-based RCCA decided 8 years ago to bring radiation oncology and surgery into the practice, D’Amato’s group instead formed an independent practice association with these specialists.

Health is so complex, D’Amato said, that “It’s very important to collaborate with like-minded groups with the same vision. These collaborations are necessary independence and quality and value proposition.”

Stephen Orman, MD, is pursuing yet another model. Now retired from clinical practice, he is serving as chair of the inaugural board of the American Oncology Network LLC, an alliance that provides administrative support and ancillary services to keep community practices independent. He spoke of the importance of having groups that are physician-centered, with “physician-driven goals.”

The Value to Employers

The panel discussed how community oncology practice could position themselves to an emerging group of stakeholders who, like themselves, seeks a stronger voice in healthcare: employers. As they see their costs rise, employers are getting more involved in benefit design and in selecting where their workers seek care. “Like anything else, it’s a process,” Licitra said. “It’s not easy to go to a large employer and say, ‘We should have all your cancer patients.’”

Instead, community oncologist clinics are demonstrating value by offering infusion services for non-oncology therapies and doing this better and less expensively than competitors. Once employers and patients see this, they remember the experience.

“Let’s not forget about data,” D’Amato said, and both Orman and Blau agreed that having good data to make the case is essential. “You have to be prepared to show them,” Blau said.

Licitra said learning to demonstrate value was a reason RCCA participated in every value-based program that emerged in New Jersey. “Not because every one is good—we just have a lot to learn,” he said. “we have to collect data and understand, ‘what are the levers that we can push and pull on that make a difference?’” 

The value of community oncology is in the relationships, he said. Nothing can replace the ability to pick up the phone and speak directly with the radiation oncologist or specialist who will be seeing a patient, and once a practice gets folded into a large institution, that element is lost.

The Prepared Will Survive

While aspects of value-based care have been frustrating, Licitra said the shift away from fee-for-service has changed the way practices do business. “We have changed physician culture and behavior and that’s one of the most difficult things to do,” he said. “We had people in practice 25 years who never thought about the economic consequences of what they did.”

Patton asked how—or when—community oncology’s role as a low-cost, high-value provider will become evidence to payers and patients alike. D’Amato said he believes younger consumers are savvier and will shop for healthcare services differently than their parents.

As 340B reform occurs and hospitals lose revenue, even those systems that have tried to buy out community oncology practices will look to practices for guidance on how to manage healthcare dollars efficiently, the panelists predicted. 

Licitra likened the state of healthcare to the mortgage market right before the 2008 crash: it was irrational for people without jobs to get financing, and eventually what did not make sense fell apart. Much of happens in healthcare today is irrational. “It doesn’t make sense, until it doesn’t make sense,” he said. “Healthcare is going to be very similar. When the bubble does pop, it will be the people who have prepared who will consolidate the market in the right way.”

Related Articles

Ted Okon Highlights the 3 Top Legislative Priorities for COA
CMS Expands Site-Neutral Payments, Extends 340B Drug Discounts
Bo Gamble Explains How COA Defines Value in Oncology
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up