Interviews

New guidelines from the National Comprehensive Cancer Network regarding cardiac toxicity for patients with cancer or cancer survivors should have cancer institutions talking about how to implement cardiac follow-up for patients, said Crystal S. Denlinger, of FOx Chase Cancer Center.

The increase in medical expenditures and the move to new care models in oncology will necessitate a change in culture for practice staff, said Charles Bane, MD, Dayton Physicians Network in Ohio.

Lydia Mitts, senior policy analyst at Families USA, explains the concept of a smarter deductible and the short-term impact of lower- and middle-income consumers switching plans and their understanding of their benefits.

Most employers now understand what value-based insurance design plans are, but they now have to explain it to their employees, according to Richard Feifer, MD, MPH, chief medical officer and national medical director for national accounts at Aetna, at the Value-Based Insurance Design Summit at the University of Michigan.

Neglecting patient and caregiver preferences hamstrings the development of medical technologies and engaging these stakeholders is vital, said John Bridges, PhD, associate professor of the Johns Hopkins Bloomberg School of Public Health.

In just 5 years there have been amazing improvements in the healthcare industry’s ability to conduct comparative effectiveness research, said Sarah Greene, MPH, former associate director, CER Methods & Infrastructure Program at the Patient-Centered Outcomes Research Institute.

Historically, the biggest barrier to enrolling diverse populations in clinical trials has been a lack of establishing trusting relationships between researchers and communities and their residents, explained C. Daniel Mullins, PhD, professor in the Pharmaceutical Health Services Research Department at the University of Maryland School of Pharmacy.

There are 3 potential solutions for reforming the 340B drug pricing program, according to Michael Kolodziej, MD, national medical director of oncology solutions in the Office of the Chief Medical Officer at Aetna.

Stacey W. McCullough, PharmD, senior vice president of pharmacy at Tennessee Oncology, discussed strategies for managing high-cost treatments, the impact of me-too drugs, and how clinical pathways can help physicians make treatment decisions at the point of care.

During the 5-year value-based insurance design demonstration in Medicare Advantage, the hope is that the models will show that lower cost-sharing for high-value services and providers meets the triple aim, explained A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

The challenge with data in oncology is making sense of it and connecting it in a way that clinicians can make insights that inform the care they provide patients in real time, said Robert J. Green, MD, vice president of clinical strategy and senior medical director at Flatiron Health.

While some of the misconceptions of palliative care have been cleared up over the years, it is still very much associated with end-of-life care, explained Judith Peres, LCSW-C, clinical social worker and health policy consultant.

There are a number of areas where pharmacy benefit managers can help support employers with the high-cost of specialty pharmacy drugs, but so far they have only been doing a good job in some priority areas, said Bruce Sherman, MD, FCCP, FACOEM.

The 17% decline in hospital-acquired conditions from 2010 to 2014 is the result of a decades long campaign and means lives saved, the avoidance of pain and suffering, and less costly care, said David Blumenthal, MD, MPP, president of The Commonwealth Fund.

The current dialogue occurring between payers and providers is critical in today's healthcare environment, and it's an interaction that certainly was not happening just 5 or 6 years ago, according to Ted Okon, executive director of the Community Oncology Alliance.

Initial adoption of clinical pathways grew from payers mandating their use with individual providers, but there is now greater interest from accountable care organizations and others to use pathways to reduce variation and cost while improving outcomes, explained Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Oncology, like primary care, is ripe for delivery reform, but it has remained stuck in a fee-for-service mindset, said Kavita Patel, MD, fellow in economic studies and managing director at Brookings Institution.

The Patient-Centered Outcomes Research Institute (PCORI) will approach biosimilar research the way it does research on anything else, but there is the added element of finding the right timing, said Joe V. Selby, MD, MPH, executive director of PCORI.

Glen D. Stettin, MD, senior vice president of clinical, research, and new solutions at Express Scripts, discusses what strategies for managing high-cost treatments aren't working and how they could be improved.

Patients considering using a genetic test should meet with a genetic counselor first to get a better understanding of the patient's goal for getting the test done and determine the likelihood that a test might be useful, explained Joy Larsen Haidle, MS, CGC, president of the National Society of Genetic Counselors.

The future of patient engagement in healthcare will be mobile, which should also help reduce healthcare disparities as more and more less-fortunate groups adopt smartphones, said Joseph C. Kvedar, MD, vice president of Connected Health at Partners HealthCare.

If the FDA steps in to regulate laboratory-developed tests, it will slow down innovation, add costs to the development of the product, and likely decrease the number of tests that come out, but the public health benefits of increased oversight might be worth it, said Scott Gottlieb, MD, resident fellow at the American Enterprise Institute.

While the 340B Drug Pricing Program was designed to help facilities that take care of impoverished patients with low-cost drugs, what the program has morphed into is almost the opposite of what it was intended to do, said Peter Bach, MD, MPP, director of Memorial Sloan Kettering's Center for Health Policy and Outcomes.

While the FDA could regulate diagnostic tests the way they are in Europe-through simple verification that the test is accurate-the FDA has not chosen to do that and comes closer to requiring clinical utility, explained Bruce Quinn, MD, PhD, senior director at FaegreBD Consulting.

Julie M. Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology (ASCO), and keynote speaker at this year's Patient-Centered Oncology Care meeting, discusses addressing cost of care, using value calculators, and the Medicare Access and CHIP Reauthorization Act.

The future of medicine will be creating partnerships with other providers and other healthcare organizations that are like-minded and looking to enter into value-based modes of care to create networks taht aren't narrow but are coordinated and high performing, said Farzad Mostashari, MD, former National Coordinator of Health Information Technology and co-founder and chief executive officer of Aledade.

After the Supreme Court struck down gene patents, not only is more genetic testing is being offered, but the technology of the test has expanded to the benefit of patients, said Joy Larsen Haidle, MS, CGC, president of the National Society of Genetic Counselors.

Throughout 2015, as The American Journal of Managed Care celebrated 20 years, the publication invited key healthcare industry leaders to write special guest commentary, which appeared each month in the journal.