Interviews

CMS’ decision to exclude digital health from its proposal for the Medicare Diabetes Prevention Program (DPP) has caused a controversy, explained Paul Chew, MD, chief medical officer of Omada Health.

There are 2 categories of challenges facing oncology practices as they transition to value-based payment models, said Aaron Lyss, director of value-based care for Tennessee Oncology.

Creating outside partnerships for community oncology practices is important because these partnerships move the industry towards value-based payment models, said Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care.

Drug pricing is one area where there may be potential future policy changes that impact community oncologists, said Dan Todd, JD, principal at Todd Strategy.

Employers have started to focus on fulfilling opportunities to control costs and supplying more services to help employees understand their treatment options and the healthcare system as a whole, explained Brian Marcotte, president and CEO of the National Business Group on Health.

As clinical trials get more complex and fewer patients are available to participate in any particular trial, technology is going to be critical for improving patient access to trials and making the whole process of being on a trial easier for patients and physicians, explained Amy Abernethy, MD, PhD, the chief medical officer, chief scientific officer, and senior vice president of oncology at Flatiron Health.

OCM provides tools and resources to not only help patients, but also support clinical staff with continuous education and training. Nurse Weaver describes the benefits and rewards of functioning as a team towards a common goal.

Does OCM require major changes to your practice to achieve this wholistic approach? Watch to find out what is needed to practice the “OCM Way”.

Implementation of OCM does not have to be a burden. Dr. Gor explains the implementation of OCM, potential cost savings and utilization with non-oncology patients.

OCM provides focus on individual patient cases. Learn how OCM affects the interaction between healthcare professional and patient.

Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare, discusses the partnership that is established with the implementation of episode-based payments, because now the physicians and other stakeholders have the same goal.

While the healthcare industry moves more toward value-based payment models, oncology practices are at a disadvantage because few payers truly understand the nuances of cancer care to design good oncology payment models, explained Aaron Lyss, director of value-based care for Tennessee Oncology.

Success in primary care should be based on how efficient and effective the physician is caring for the patient, and how satisfied the patient is with his or her care, rather than how many patients a physician is seeing in a day, said Charlie Fazio, MD, senior vice president and medical director of HealthPartners.

With 35% of Americans having prediabetes, prevention is clearly a priority, but many strategies have not bee translated into clinical practice because there is no system for reimbursement yet, explained Paul Chew, MD, chief medical officer of Omada Health

Flatiron Health focuses on helping community oncologists because they still care for the majority of patients with cancer and make it possible for patients to get care without traveling long distances, explained Nat Turner, co-founder and CEO of Flatiron Health.

While the ongoing healthcare debate in Congress creating a lot of uncertainty among the healthcare industry, there are areas of certainty and optimism, said Dan Todd, JD, principal at Todd Strategy.

Despite the politics involved in healthcare, it seems unlikely that the industry to going to stop its migration toward more accountability for quality, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

As the healthcare industry moves more toward value-based payments, practices have a real need for data that is usable and can help them succeed in new payment models, Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care, explained at OncoCloud '17, held by Flatiron Health September 16-17 in Las Vegas, Nevada.

Although direct spending on primary care is low compared with other areas in healthcare, spending on innovations in primary care is important, explained Charlie Fazio, MD, senior vice president and medical director of HealthPartners.

There are a number of challenges with implementing value-based payment models in oncology, but it's an exciting time and offshoots of the Oncology Care Model (OCM) can "revolutionize" cancer care delivery, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team, discusses how Medicare will address and possibly change its biosimilar policies as the FDA offers more guidance and as biosimilars become more prevalent in the market.

Having employers and accountable care organizations agree on expectations is necessary for better alignment of care offered, explained Brian Marcotte, president and CEO of the National Business Group on Health.

Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare, discusses off-label communications and how coverage determinations are changing along with the production of new immunotherapy agents.

High drug prices have created barriers to accessing medications, and Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health, suggests that the pricing algorithms need to change in order to improve this dilemma.

Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, explains how previous experience with alternative payment models helped a smooth transition into the Oncology Care Model (OCM).

States are addressing biosimilars in different ways and putting different regulations in place as biosimilars become more prevalent in the market, explained Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team.

There are 3 different areas of healthcare that all face different challenges in implementing population health and adopting new reimbursement models, explained Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Charlie Fazio, MD, senior vice president and medical director of HealthPartners discusses how to balance different payment models in order to understand their impacts on cost and patient outcomes when they are implemented.