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Conference Coverage: Community Oncology Alliance

Maggie L. Shaw and Mary Caffrey
Coverage from the Community Oncology Alliance Virtual Meeting, held April 23-24, 2020.

What Matters to Our Patients Matters to Us, and We Must Keep Up, Panel Notes

Community Oncology Alliance (COA) 2020 conference, held virtually, kicked off with the panel discussion “Top Oncology Issues Now & Looking Ahead,” led by Bo Gamble, BBA, COA’s director of strategic practice initiatives. Topics covered ran the gamut, from Zoom being everyone’s new middle name, to telehealth, to caring for patients’ medical and social needs, and beyond. Permeating all facets of this discussion was coronavirus disease 2019 (COVID-19) and how it seems to have fundamentally changed the world of oncology care, especially how physicians and cancer caregivers and providers interact with their patients and loved ones.

Joining Gamble on the panel were:

• Kathy Oubre, MS, chief operating offi cer, Pontchartrain Cancer Center

• Barry Russo, MBA, chief executive offi cer, The Center for Cancer & Blood Disorders, and conference co-chair

• Robert Braun, RN, MA, vice president, Operations and Integration, Regional Cancer Care Associates, LLC

Panelists echoed one another’s sentiments throughout, touching upon common concerns that included telehealth; maintaining clear communication, perhaps being more upfront now than before; the fact that we are in unchartered territory and have to adjust on the fly; and that COVID-19 is a force majeure, an unforeseeable circumstance. All the while, they stressed that it is the oncology community that has to keep up with its patients while helping them navigate an ever-adjusting

health care system.

Gamble opened the discussion with this telling question, “How do you think the current pandemic is shaping the challenges for the future?” The panelists each provided an overview of their top concerns. “We are trying to maintain a sense of normalcy for patients, knowing that permanent adjustments will need to be made when this public health emergency is over. What will that look like?” Oubre proff ered. “Telehealth is here to stay. CMS is interested in hearing our thoughts and our comments on shaping that policy as we move forward.”

“For practices that operate within a financial-risk model, I think we’re going to need organizations, our local representatives and those people on the federal level, to help us navigate those waters [and] come to a happy medium where our practices are not only stable, but where we can provide services to our patients and are ready to move forward,” Braun said.

Russo stressed, “Communication eff orts need to expand and focus on keeping up the electronic aspect, because patients will be [physically] coming in to our practice less often and will continue to social distance. We will have to adapt to our patients, because they are adjusting so fast to the electronic world.

How do we restructure, especially in a value-based world, our needs to interact and communicate with the patients on a much more frequent basis, but in a way that takes into account all the focus on social distancing and protection and patient expectations?”

Gamble next asked about the possible future redesign of reform models, given where we are today. Payer conversations predominated, but given the current ongoing uncertainty, the panelists brought up how important it is to think outside the box and be able to adjust on the fl y, all the while collaborating and keeping the lines of communication open.

“We are in 2-sided risk with the OCM [Oncology Care Model], so we’re certainly very concerned about that,” Russo stated. “And we’re very concerned about the implications of some of our folks who have ended up in the hospital because of COVID-19, and the impact associated with that. And we don’t yet know when that means, and it’s been a challenge.…Going forward, we’re going to have to talk with the payers when these kinds of things, like a pandemic, happen.”

Oubre added, “We’re just trying to keep our practices afl oat and provide the best patient care we can, regardless of the cost or what that looks like. I mean, pandemic, public health emergency, these were not words in our lexicon 6 months ago. I think it’s time to start collecting data and have conversations, and we’re going to have to work through this together.”

“The commercial payers have stepped up and have been very responsive in answering our questions. Obviously, COVID-19 is defi nitely going to have an impact on payment reform,” Braun noted. “But I think collectively that we’re still going to really see growth in value-based contracting. I think we will have to have better business effi ciencies to ensure that our practices are viable and being profi table.”

Gamble then asked about how these challenges have changed how oncology will look at roles in the whole care journey itself, moving forward. Patient satisfaction was the name of the game, in all circumstances, especially in patients’ psychological well-being and addressing their needs beyond just the medical. All the while, outcomes must be kept in mind.

“People are losing their health care or they are unemployed. We need to remember that, when we’re looking at that patient as a whole. We need to address those social aspects as well,” Oubre emphasized.

Braun responded, “I think that we live in a world where we’re taking care of very discerning patients. They want to know where they’re getting their health care, how they’re getting their health care, who is giving them health care. It’s an opportunity to actually ask the patient what matters to them the most and what has concerned or what is concerning them, and not from just a physical point of view.”

“[We have to address] how we remain that safe place,” Russo remarked. “I think we will have to quickly adapt to fi nding the right patient electronic communication system structure. We are their safe place, and we have to remain so because it’s a big part of the healing process, a huge part.”

What major hurdles will oncology have to overcome, and what adjustments will the cancer care community have to make to continue to meet patient expectations in a post–COVID-19 world? Have doctor–patient interactions fundamentally changed? What about the needs of all the parties? These questions hung in the air as the panel discussion came to a close.

“I want you to look at your crystal ball and tell me what it looks like 5 years from now and 10 years from now for your world,” Gamble asked, to conclude the discussion.

“I think we’re all going to have to step it up in terms of our communication methods, and not just via email or text, or telemedicine, but other methods of how we communicate between practitioners,” Braun stated.

Oubre observed, “Telehealth is here to stay. Social distancing, in some fashion, is here to stay. I think it’s important that we all have a seat at the table, though, to fi gure out what that is going to look like. And we have to do that [while] keeping the patient at the center of everything we do, to be able to [go on] providing them with that safe environment.”

“I think what we’re learning in value-based care is that all the other pieces of what’s happening with a patient, all those pieces are part of the journey,” said Russo. He predicted, “I think that over the next 5 years, because of value-based arrangements, because of our access to data, and because of our need and requirement to connect more often to patients electronically, we’re going to have a better picture of the longitudinal journey.”

Communicating with patients more often, taking care of their needs beyond those that fall on the oncology spectrum, and getting a more complete picture of their needs: These are the top community oncology issues now, and they will continue to be, looking ahead. 


COVID-19 Adds New Wrinkle in Shift to 2-Sided Risk in Oncology Care

Asking federal officials to give more time to the oncology practices that are pursuing alternative payment models (APMs) before shifting to 2-sided risk was already a worthy request. But the global pandemic of coronavirus disease 2019 (COVID-19) gives this entreaty more urgency, according to the co-chairs

of the payment reform committee of the Community Oncology Alliance (COA), which held a panel discussion on April 23, the fi rst day of the group’s virtual meeting.

Moderated by Bo Gamble, BBA, COA’s director of strategic practice initiatives, the discussion featured co-chairs Kashyap Patel, MD, chief executive officer of Carolina Blood & Cancer Care Associates, and Lalan Wilfong, MD, executive vice president for value-based care and quality programs at Texas Oncology.

It demonstrated that several practices taking part in the Oncology Care Model (OCM), advanced by the Center for Medicare and Medicaid Innovation (CMMI), were willing to commit to 2-sided risk despite their struggles thus far to achieve bonus payments under the model.

COA surveyed 175 practices and received 68 responses, learning that 32% of practices planned to pursue 2-sided risk despite not having received a performance-based payment in the fi rst 4 evaluation periods. “That was really amazing to us,” Gamble said. For the practices, however, value-based payment represents the future, and they vowed to keep trying.

Patel, among the few practice leaders who received a bonus payment in each of the first 4 periods, explained how give-and-take among COA practices enrolled in the OCM has led to critical adjustments that have kept the cause of payment reform going. In particular, collaboration led to changes in calculations for stop loss

that would have caused widespread abandonment of the OCM. But that collaboration is crucial now, because under the original schedule, the OCM was set to end and a new model, Oncology Care First (OCF), was planned to replace it starting next year.

And then came COVID-19, which changed everything. For starters, the fi nal look at OCF is on hold, Patel said, because CMS is busy dealing with the fallout of

the pandemic. “We were expecting the model to come out by spring [2020],” he¯said, but with COVID-19, “Everything has been postponed.”

Even before the current crisis, practices were asking for more time to get a feel for 2-sided risk—because oncologists are at widely varied states of readiness for such a change. Add a pandemic that has forced practices to conduct visits via telemedicine and puts patients with cancer at higher risk of hospitalization because they are immunocompromised, and all bets are off.

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