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Evidence-Based Oncology June 2019
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Institute for Value-Based Medicine
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AJMCtv® Interviews, June 2019
Produced by Samantha DiGrande and Jaime Rosenberg

AJMCtv® Interviews, June 2019

Produced by Samantha DiGrande and Jaime Rosenberg
AJMC®TV interviews let you catch up on what’s new and important about changes in healthcare, with insights from key decision makers—from the clinician, to the health plan leader, to the regulator. When every minute in your day matters, AJMC®TV interviews keep you informed. Access the video clips at ajmc.com/interviews. 

Rick McDonough, MD, Past President of the Florida Society of Clinical Oncology (FLASCO)

Why is now a great time for people to enter the field of oncology?

One of the things that drew me to this is that it touches on so many people’s lives [and involves] so many different aspects of medicine. As we go through medical training early on, we see all the different aspects of the body, and this is a field [in which] many of these things come together, because so many things [have an] impact on cancers—how they develop, how you address them while [patients are] going through treatment….Beyond that, the advances are coming so rapidly on this that the nature of the care of cancer is evolving quickly from year to year. One of our speakers was talking [about how,] through the course of his career, just how drastically things have changed and how much longer survival has been, how patients are coping, how many more cancer survivors…we have. And that’s another thing too: looking at getting together physicians and groups from across the state to work on things like survivorship. So, how does the patient fare after they’ve completed their cancer treatment, and what are those steps for them going forward? 

What are the benefits of being a FLASCO member?

In talking about education and inclusiveness, the ability to connect to your peers and people in different disciplines that touch on cancer care [is vital]. Collaboration is, I think, one of the key things in medical care, whether that’s on the small level of within an office of the team of people that are day by day helping you take care of cancer and blood cancer patients or whether that is across the broader spectrum; whether that’s a group or a hospital system [or] whether that’s an academic medical center [where] you have a large group of people who are focused on the mission of that entity. 

We’ve really sought to expand that farther across the state so that we can bring together people from different geographies within the state, different settings and the way that they care for cancer patients, whether that’s a single doctor in a practice and their staff or whether that’s large institutions; whether that’s academic or even private practices that are large and spread across large areas of the state. So, by being a part of this membership, you get access to education, information, resources, [and] materials that are, hopefully, going to be helpful in the care of cancer patients [and] make sure that in making those connections, the more that we all collaborate, the better [we] can become. 

Beyond that, [when] listening to, for example, 1 of the fellows who was present for [the] discussion, it was really eye opening particularly for people that are new in their career [they were] able to say, “This is information that I need to know,” –beyond just the scientific and the medical aspects of their training… they can…understand more of the big picture of what’s involved, and as this gets more and more complicated—and currently in oncology, change is so rapid in both the science and the mechanism of how we deliver care—[we can] collaborate to make those advances and continue to move this forward. 

Michael Kolodziej, MD, Vice President and Chief Innovation Officer at ADVI Health

What are some of the highlights from your panel on payment models?

I was fortunate enough to moderate a panel on alternative payment models [APMs]. We had a representative from Moffitt Cancer Center, a representative from the Memorial Healthcare System, and a representative from Florida Cancer [Specialists]. So that’s great, because those are 3 very different practice settings, all of [which] are knee-deep in APMs. 

Two of the 3 are involved in the Oncology Care Model [OCM]. Moffitt is not in the OCM because they’re a PPS [prospective payment system]– exempt hospital and were not allowed to participate. 

I think the take-home message is that overall, the OCM has been a positive experience for the 2 groups that participated. They’ve learned a lot about how to optimize care delivery. They’ve looked at where they could improve care; they looked at the opportunities to improve the patient experience and, at the same time, [were] cognizant of cost. 

One of the important takeaways was that practices in the OCM would do it again, and that’s important. The second thing was that all 3 groups are participating in other APMs, and that is really good news. I think when the OCM was launched, it was somewhat disappointing that so few commercial payers chose to participate. I was at Aetna at the time, and we did choose to participate. 

Nonetheless, all 3 groups that we had on our panel today are participating in APMs, and that’s good news, because I believe that the knowledge gained—for example, in the OCM—is transferable to these other models, and our panelists said as much. 

Thomas Marsland, MD, Medical Oncologist

Innovative therapies are being developed in cancer care, but these treatments can be extremely expensive. How does financial toxicity affect patients, and how can it be mitigated?

I think that [financial toxicity] is the biggest challenge we face. We have these great new therapies, but they come at a fairly significant cost. But I think, as one of the other speakers mentioned, [that] the cost of the drug is only one part of a spectrum of costs. You know, it’s the cost of the administration, the cost of managing the toxicities, the hospitalizations, the emergency room visits [etc]. So I think, if all you’re looking at is the cost of the drug and that drug is X versus a drug [that costs] less [that’s 1 thing]— [However], if you’re looking at it as a continuum or more of what they call an episode of care, it may be that although the drug costs more, when you look at the total spectrum of care over a period of time…the drug actually saves money. 

A couple of the medical directors from several of the big payer communities have made a point that clearly drug cost is a significant piece, but it’s not the largest piece; I mean, end-of-life care, appropriate planning—using the drug at the right time and for the right patients—I think is one way that we can help to manage that cost and allow patients to get the type of care that they need. 

Luis E. Raez, MD, Incoming President of the Florida Society of Clinical Oncology (FLASCO) 

What are some of your goals as the incoming president of FLASCO?

[At] FLASCO, we have several goals. We are working with 12 industry partners in statewide projects that benefit cancer therapy outcomes and patients. For example, one of the projects I love the most because I’m a lung cancer doctor is lung cancer screening. Statewide, we screen [just] 5% of all the patients that are at risk of having lung cancer. It is our goal to increase significantly that proportion.…We have other projects regarding access to drugs, payment of drugs, [and] healthcare outcomes, [and] most of these projects involve patient care and quality care. 

Stephen Grubbs, MD, Vice President of Clinical Affairs of the American Society of Clinical Oncology (ASCO)

What are the most important differences between the Patient-Centered Oncology Payment [PCOP] model and the Oncology Care Model [OCM]?

PCOP is an alternative payment model [APM] that ASCO published in May of 2015 after several years of work by our volunteers and staff. What’s interesting is [that] the OCM from CMS was actually introduced the summer of 2015 and started in the summer of 2016, and there are many similarities between the 2 even though they were independently made. 

Over time, we’ve made some adjustments in the PCOP model that will be probably published this summer. We’ve taken some of the lessons learned from the OCM experience and other APMs in the oncology space and have actually refined our model some. 

Initially, some of the differences were important to practices in that the OCM was requiring total cost of care in considering the calculations of how well a practice was performing in it. The PCOP model initially said, “We probably should have our physician practices responsible for the total cost of care that they were controlling.” So, some issues about the cost of drugs became an issue…[and] we’ve tried to adjust that in our new model. 

The other thing that I think you’ll see different as we’ve refreshed our model—or are in the process of doing it—is [that] we’ve taken a different approach, because I think what we’ve learned is that [no 1-size] model will fit everybody in the country.…I think the OCM has [a] very sophisticated group of practices in it that we all know are really wonderful practices, but [there are] a lot of practices out there that don’t have the resources. We’re kind of designing our refresh model so that many other types of practices can perform in the new model if someone wishes to take it up and use it. 

One of the big differences is [that] we’ve kind of moved our model away from [the idea that] “across the country, everybody should perform in this type of model” to more of a regional-based model because, again, care of medicine is local, and you need to make adjustments for what your local community needs and wants.…I think that’s where we’ve taken a little different [approach in how] we’ve refined our model now. 

The other part of our model that I think [others] are beginning to recognize is, you have to have a certain level of a care delivery system within your practices to make any of these things run properly, and therefore we’ve put a lot of thought into what the practices will need to have in their infrastructure to be able to perform well in an APM. 

Those are some of the differences, and it’s still an evolution.…OCM’s changed over the last several years, too, to the credit of CMMI [the Center for Medicare & Medicaid Innovation], so I think all these things— from my perspective—are experiments, and they’re pilots, and we need to learn from them. Not any one is by itself going to get the answer right the first time around. 

Blase Polite, MD, Associate Professor of Medicine and Executive Director of Accountable Care at The University of Chicago Medicine

Why did you want to focus on the state of the Oncology Care Model [OCM] at this meeting of the Institute for Value-Based Medicine?

 
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