Currently Viewing:
Newsroom

Not Just the "Soft Stuff": How Data Deployment, Artificial Intelligence Can Restore Relationships in Oncology Care

Mary Caffrey
The revolution in cancer care isn’t just about the wave of life-saving therapies, or the role of genetics in pinpointing exactly who should get which drug and when. As Ray D. Page, DO, PhD, FACOI, tells it, change also means getting back to the basics, so that the relationship between doctor and patient drives care—not insurance companies or Medicare or rules from the FDA.
The revolution in cancer care isn’t just about the wave of life-saving therapies, or the role of genetics in pinpointing exactly who should get which drug and when. As Ray D. Page, DO, PhD, FACOI, tells it, change also means getting back to the basics, so that the relationship between doctor and patient drives care—not insurance companies or Medicare or rules from the FDA.

Giving patients what they need at a fair price—not care they don’t need or can’t afford—is how Page envisions transformation. The president and director of research at The Center for Cancer and Blood Disorders, in Fort Worth, Texas, has plenty to say about the barriers that are preventing shared decision-making—from the bureaucracy of “Obamacare” to the failed promise of electronic health records (EHRs), which he called, “the number one cause of physician dissatisfaction.” (A February 2019 study in the Journal of the American Medical Informatics Association concurs.1)

Connecting payment to quality, which includes not just outcomes but what Page calls “the art of medicine” is a tall order. And in oncology care, he said, there’s a long way to go. Finding better tools to restore the doctor-patient relationship was on Page’s mind March 7, 2019, as he  moderated a meeting of the Institute for Value-Based Medicine in Oncology, an initiative of The American Journal of Managed Care®. The session at the Four Seasons, Las Colinas, in Irving, Texas, which featured presentations and discussion from John Cox, DO, MBA, FASCO, professor of medicine, University of Texas Southwestern; Kashyap Patel, MD, chairman, Carolina Blood and Cancer Center; Barry Russo, CEO, The Center for Cancer and Blood Disorders (CCBD); and Tony Willoughby, PharmD, president, Pharmacy Services, StratiFi Health.

“You should be able to negotiate a rate for services at a fair market value price,” Page said, as he discussed his challenges with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),2 which sought to shift healthcare away from fee-for-service (FFS) toward payment based on quality.

But Page said much of MACRA has only made things more complex for oncology practices. Given the choice between the Merit-based Incentive Payment System, or MIPS, and an alternative payment model (APM), Page’s practice pursued the Oncology Care Model (OCM), an APM regulated by the Center for Medicare and Medicaid Innovation (CMMI).3 “The complexity was just unbelievable,” he said.

CMMI hasn’t been able to answer all Page’s questions on how the model works, or how practices are rewarded for quality. A big challenge—not just for Page’s practice but for many others—is the inability to control which patients come through the front door or what types of cancer they have, which in turn drives what type of therapy they will need. “As you’re dealing with a population, it’s like dealing with a roulette wheel,” he said.

Creating the Team Concept

Cox was in private practice for more than 25 years before joining UT Southwestern as medical director of Oncology Services at Parkland Health and Hospital System. He agreed with Page that the challenges of adjusting to the shift from FFS are very real. “The external forces in healthcare—they aren’t going away, and they are only going to become more complex,” he said.

A solution comes from learning to practice in teams, of creating high expectations to go along with the use of data that drives APM insurance contracts. But things like risk stratification of the patient population start with a staff that embraces this process. “Beyond the mechanisms of doing this, of paying attention to the data, the change that is greatest in healthcare is managing people and expectations,” Cox said.

“When you think about change management, this is often viewed as the soft stuff that gets put off at the end of the day,” he said. But Cox said that is shortsighted. Putting the right people in the right roles is critical to a practice’s success under an APM, which relies on nurses and non-clinical staff full embracing their roles for everything from nutrition counseling to survivorship planning.

“To be successful in the world of APMs, we are going to have to pay a lot more attention to these leadership structures,” Cox said. “That may require some hard decisions in your organization.”

Metrics have a role in measuring who is thriving in their team function and who is not, and this can promote change. But the key players are strong leaders who can cut through the silos that have traditionally defined cancer care and express a shared vision. “Culture eats strategy for lunch,” he said.

A project by the American Society of Clinical Oncology (ASCO) and the National Cancer Institute brought together 21 teams that submitted vignettes on applying team principles to oncology practices. The need for teams to work interdependently came through, and the results were published.4

Teams are essential in today’s environment, Cox said, given the “soul sucking” challenges that confront physicians. Science and therapeutic discussions are often limited by social determinants of health, “when patients don’t have access to care,” and clinicians lack the mechanisms to address these issues.



 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up