Interviews

E. Magnus Ohman, MD, FRCPI, FESC, FACC, FSCAI, professor of medicine at Duke University Medical Center, discussed the results of the GEMINI-ACS-1 trial comparing rivaroxaban and aspirin in acute coronary syndrome (ACS), which he and his co-authors presented at the American College of Cardiology 66th Scientific Session. They found no significant differences in the primary endpoints and ischemic outcomes, though further research will be necessary to inform clinical practice.

At the Putting Care at the Center conference, panelists presented their successful models for caring for high-needs patients, which were summarized by Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers. These models provided examples of how to scale up innovative approaches to care delivery and interventions.

There are more costs involved in cancer treatment than just the price of the drugs, said Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health. The process of selecting the right treatment also factors into spending, so it is important for patients to get a second opinion.

The EINSTEIN-CHOICE findings presented at the American College of Cardiology 66th Session demonstrated some promising outcomes, showing that rivaroxaban is a viable option for long-term prevention of venous thromboembolism in some patients, said Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, professor of medicine at the Hofstra Northwell School of Medicine.

A worldwide study of rheumatoid arthritis patients and providers found that they often focus on separate goals, which can lead to a disconnect in communication, according to Allan Gibofsky, MD, professor of medicine and public health at Weill Cornell Medical College and an attending rheumatologist at Hospital for Special Surgery.

If the burden of cost sharing no longer fell on cancer patients, they would be more likely to access care and maintain treatment as prescribed, leading to improved outcomes, according to Samantha Watson, founder and CEO of The Samfund. When faced with high copays, patients are more likely to skip appointments or take only half of their prescribed medications.

The use of biomarkers in immunotherapy has some technical and biological limitations, and is complicated further by the qualitative aspect of cancer treatment, said David Fabrizio, of Foundation Medicine, Inc. A genomic-based solution could help develop more unified quantitative approaches.

Partnering with local nonprofits with expertise in various areas, such as food support, vocational services, and mental health case management, Hennepin Health has been able to successful manage the health of a complex population, explained Ross Owen, health strategy director of Hennepin County.

Oncology physicians and nurses need to listen to their patients’ needs and expectations to determine the right way to present information on cancer treatments, including immuno-oncology, according to Debra L. Madden, cancer research advocate and patient representative.

The increased emphasis that the Affordable Care Act and Medicare accountable care organizations (ACOs) placed on prevention is important in reducing the high cost of older patients, especially as the baby boomer generation reached retirement age, explained Mariétou Ouayogodé, PhD, post-doctoral fellow at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.

Jonathan Hirsch, founder and president of Syapse, was working to earn a PhD at Stanford when he noticed that physicians needed better software systems in order to successfully implement precision medicine. He then dropped out of graduate school to found Syapse, a health IT company that provides physician-friendly software.

When caring for patients with diabetes, it’s important for providers to take into account the patient’s culture and how it can affect communication styles and treatment preferences, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center.

Advances in technology has had a profound impact on the National Library of Medicine and allows the use of virtual reality to deliver information in new ways to patients, explained Patricia Flatley Brennan, RN, PhD, director of the National Library of Medicine.

The cost of oncology care has increased significantly in recent years, leading employers to worry about how they can provide consistent benefits for employees with cancer and their family members, according to Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.

Patients with obesity often face severe stigmatization from healthcare providers, which can discourage them from seeking help, according to Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital. She explained that the “dismal” obesity education in medical schools can lead physicians to judge obese patients unfairly.

Years of experience as an oncology nurse practitioner have underscored the importance of evidence-based resources for both patients and clinicians, says Carrie Stricker, PhD, RN, AOCN, chief clinical officer and co-founder of Carevive.

When discussing value in oncology, the outcomes that matter are those that are important to the patient, said Stuart Goldberg, MD, chief medical officer, Cancer Outcomes Tracking and Analysis, John Theurer Cancer Center. He also discussed how the use of data to stratify patients is important for providing value-based cancer care.

The main focus of Humana’s business activities is to provide a better experience for patients and physicians, according to Roy Beveridge, MD, chief medical officer of Humana. This patient-centered approach is informed by his work as a practicing oncologist, where he learned to think about clinical programs from the perspective of the patient.

Convenient care clinics like MinuteClinic allow patients without regular primary care to become more informed about their health and medications, according to Kristene Diggins, FAANP, CNE, NEA‐BC, DNP, MBA, manager of professional practice at MinuteClinic.

As healthcare increasingly rewards quality and value in care delivery, Aetna hopes that 75% of its payments will be value-based by 2020, according to Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

Despite the number of available drugs for treating rheumatoid arthritis, many patients still have untreated symptoms, according to Grace C. Wright, MD, PhD, clinical associate professor of medicine and attending rheumatologist at New York University Langone Medical Center. Treatments could be tailored more efficiently if tests helped to predict which individual patients are most likely to respond to a medication.

Insurers can engage the practices they work with by building a sense of trust and open communication with the providers, according to Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ.

Hospitals don't always adequately prepare patients for the reality of cancer treatment and all the ways it might affect someone's life, explained Melissa Thompson, MBA, healthcare strategist, patient, and self-advocate.

Contrary to concerns that telemedicine could be overused, some programs are seeing lower involvement than expected, according to Anne Schmidt, MD, associate medical director at Blue Cross and Blue Shield of Alabama.

The Oncology Care Model (OCM) can challenge providers who are overwhelmed by the wide scope of data involved, according to Barry Russo, CEO of The Center for Cancer & Blood Disorders. He explained the importance of educating staff, physicians, and patients to help ease the journey towards any new model.

Genomic-based solutions can help identify which cancer patients will respond better to treatment based on biomarkers, said David Fabrizio of Foundation Medicine, Inc.

Recent advances in insulin formulations and innovative drug classes have made it easier than ever to manage diabetic patients’ glucose levels, according to Yehuda Handelsman, MD, FACP, FACE, FNLA, medical director and principal investigator at the Metabolic Institute of America.

Precision medicine has demonstrated clinical utility and cost-effectiveness, which is why many believe this approach will be key to value-based cancer care in the future, said Jonathan Hirsch, founder and president of Syapse.