Interviews

The Michael J. Fox Foundation has implemented a variety of resources for people with and without Parkinson disease to address emerging issues precipitated by the COVID-19 pandemic, said Rachel Dolhun, MD, vice president of Medical Communications at The Michael J. Fox Foundation for Parkinson Research.

Innovations to promote communication between primary care providers, oncologists are vital to delineate distinct roles in oncology patient management, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

Anti-anxiety and anti-insomnia prescriptions surged after mid-March after the coronavirus disease 2019 (COVID) pandemic was declared, said Glen Stettin, senior vice president and chief innovation officer at Express Scripts, who discussed the use of mental health and behavioral health prescriptions during the current public health emergency.

Oncology practices in 2-sided risk arrangements have reported mixed results, pointing to the need for more time to make the transition, said Michael Diaz, MD, president of Community Oncology Alliance.

Many patients when they start their cancer therapy get so ingrained in the cancer world that their oncologist just becomes their main point of contact, but we have to do a better job at letting the patients know that the PCP still is an integral part of their care, said Kelly Filchner, MSN, director at Fox Chase Cancer Center Partners.

The clinicians and nurses at Pontchartrain Cancer Center address the education behind the clinical trials, which helps patients understand that they can have access to cutting edge therapy that they would not otherwise have access to, said Kathy W. Oubre, MS, chief operating officer at Pontchartrain Cancer Center. Kathy Oubre is additionally scheduled to speak at the Community Oncology Alliance Virtual Meeting, which runs from April 23-24, 2020.

The American Journal of Managed Care® spoke with Lindsay Bealor Greenleaf, JD, MBA, Vice President of Policy, ADVI Health, about CMS’ recent enactment of the 2021 Medicare Advantage rate announcement, and the effects of COVID-19 on Medicare Advantage. This transcript has been edited slightly for clarity.

We're sending patients eye charts via email, doing zoom visits or telehealth visits by video or audio– it's been interesting to see that ophthalmologists can adapt to to this. I think that's going to be something that will stay on in some way, shape, or form after this pandemic subsides, said Sonal Tuli, MD, Clinical Spokesperson for the American Academy of Ophthalmology (AAO).

The expansion of Medicare Advantage benefits patients, but presents challenges in oncology care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.

Networking with other practices, sharing ideas, and getting physicians involved in the process can aid community practices moving to alternative payment models (APMs), said Michael Diaz, MD, president of Community Oncology Alliance.

Prakash Bhuyan, MD, PhD, vice president of clinical development at Inovio, discusses the company's vaccine trial for coronavirus disease 2019 (COVID-19) as well as its DNA medicine platform for rare genital cancers.

Developing an expansive program to meet the needs of all of our patients, at all education levels, is 1 of the biggest challenges we face at Pontchartrain Cancer Center, said Kathy W. Oubre, MS, chief operating officer at Pontchartrain Cancer Center. Kathy Oubre is additionally scheduled to speak at the Community Oncology Alliance Virtual Meeting, which runs from April 23-24, 2020.

Age and severe comorbidities were among the differences found when real-world data on Medicare patients receiving CAR T-cell therapy was compared to clinical trial outcomes, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

MRD assessments are probably 1 of the most powerful predictors that we have to see how well a treatment has worked, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Following the International Myeloma Working Group criteria, we usually check for minimal residual disease when the patient has reached a complete remission or is very close to complete remission, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Part of the reason COA recommended a 'ramp up' period is we need time for the vendors to understand what they need to be incorporating in their software, said Michael Diaz, MD, president of Community Oncology Alliance.

"I am not convinced yet that the Oncology Care First Model truly takes into account necessary elements, including high-cost drugs," said Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists.

Although it is true that there are people who still don't use minimal residual disease (MRD) testing, I think that its use is going to pick up based on results of emerging clinical studies, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

"There is this mentality that hospice means the patient is going to die very soon, and that's really not true," said Maen Hussein, MD, physician director of finance at Florida Cancer Specialists.

Right now, it's not really used for decision treatment in most centers, but there are a lot of studies that have started this year or starting next year that have MRD as an endpoint so we will see, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Sharing records and encouraging conversation will promote better collaboration between primary care and cancer care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.

"We want to make sure practices have time to learn, understand, adapt, and modify, to a new Oncology Care Model," said Michael Diaz, MD, president of Community Oncology Alliance.

Several challenges arise when using real-world data derived from claims to study the impacts of CAR T-cell therapy on Medicare patients, said Karl Kilgore, PhD, senior research analyst at Avalere Health.

Patient safety is paramount when deciding how to roll out a new program or even if a program should be developed or not, said Jeremy Whalen, PharmD, BCOP, specialty clinical program director for oncology at Prime Therapeutics.

There are studies exhibiting progression within treatment for smoldering multiple myeloma, but nothing has been FDA approved yet, said Elisabet Manasanch, MD, assistant professor in the Department of Lymphoma/Myeloma and Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center.

Educating primary care providers and patients on accessible lung cancer screenings can help reduce lung cancer mortality, said Maen Hussein, MD, physician director of finance at Florida Cancer Specialists.

When patients present to the emergency department (ED) with sickle cell disease (SCD)–related pain, they often have been experiencing that pain for days, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

There has been significant improvement in payers' understanding of site of care issues, but steps still need to be taken to address these issues, said Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists.