A session on industry reconfiguration covered differed business models for oncology, including payer acquisition of networks and collaboration with academic centers and primary care.
The rise of pharmacy benefit management. Vertical integration. Health care consolidation. Payer acquisition of provider networks. If there is a business trend in health care, it will find its way to oncology, because that’s where the money is, according to a panel that met Thursday during a meeting of the Association of Community Cancer Centers (ACCC).
The session, “Industry Reconfiguration: Who’s the Boss?” brought together health care consultants and leaders from different delivery models during ACCC’s Annual Meeting & Cancer Center Business Summit in Washington, DC. Michael Kolodziej, MD, vice president and chief innovation officer for ADVI Health, LLC, moderated the discussion featuring:
Kolodziej warned that the old paradigm of hospitals vs community oncology battling for market share will fall by the wayside, and the threat of health care outsiders getting into cancer care hasn’t disappeared just because the Haven venture failed. He predicted Amazon will return to oncology—although not everyone agreed.
“I’m here to tell you that the world is bigger than hospitals—and the world is changing,” Kolodziej said.
Blansett offered with an overview of recent consolidation trends, notably the trend of payers gaining control over provider networks.
“Once these referral systems start working well,” he said, payers will “channel patients into highly affiliated, highly aligned pathways-driven networks in oncology.” He predicted that this would allow payers to select 1 or 2 providers in a market and drive business to them, increasing their leverage to drive down prices.
It won’t just be the big national players doing this, Blansett said. Major regional health systems, including those affiliated with academic research centers, will “get into this game.”
Levine, who had worked with Martino at a payer years ago, outlined how City of Hope had grown to 35 sites in Southern California: partners came to leadership and asked for expansion because patients were driving long distances for world-class care and to take part in clinical trials. In 2020 came the launch of AccessHope, which is offered through employers to offer consultation on complex cases without requiring the patient to travel. Northwestern, Dana-Farber, and Emory’s Winship cancer centers are now part of AccessHope.
Martino runs an at-risk primary care model that works with 3000 physicians in 18 markets. The model has arrangements with oncologists to ensure that when patients need cancer care, the primary care providers are kept informed of what is happening in treatment, as they are assuming the risk.
Kolodziej asked Martino, “Why do you care about oncology?”
Oncology, heart failure, and musculoskeletal care are the 3 major cost drivers, Martino explained, and a primary care model cannot assume risk without taking responsibility for care coordination for these areas. “When cancer care starts, everything else stops,” he said. “If we are going to be responsible for outcomes, we have to find oncology practices that will change that paradigm,” through subcapitation arrangements.
Similarly, Kolodziej asked of Wydra: “Why does Optum care about oncology?”
Optum Care, he said, seeks to build a network that is accessible and delivers high quality care. Wydra, who is a nurse by training, said Optum Care contracts with physicians both in different ways, and there are “firewalls” between Optum Care and UnitedHealthcare, and not the “fluidity” that many assume.
“Now, don't get me wrong—like everybody else, because I do have what I call tools, let's say, or access as a [pharmacy benefit manager], would I like our practices to utilize those for our patients to receive their drugs? Absolutely,” he said. “Especially if that process is seamless—and it gets the drug in that patient's hands as quick as possible.”
Asked how City of Hope wants to “change the landscape,” Levine said there’s great interest in addressing disparities, both in outcomes and in clinical trials. Cancer is now hundreds of diseases, and when patients lack access to expertise, they are dying based on their race and socioeconomic status, he said. “Whatever we do in Southern California isn’t enough to affect the whole population.”
Kolodziej asked why Amazon didn’t get into providing this kind of service via telehealth. Blansett said it always looks attractive for a player outside of health care to try to into oncology, given the amount of money involved. Until they try, that is.
Levine said City of Hope’s foray into AccessHope doesn’t come lightly—for years it had collaborated with Kaiser Permanente to provide bone marrow transplants, for example. But Kolodziej said based on the example he sees outside New York City—of Memorial Sloan Kettering competing with local community oncology practices—there’s definitely a competitive element.
Kolodziej then asked how the various entities went about building networks. Martino said his VillageMD switched out one oncology practice after its costs rose following acquisition by a local hospital system. There is also a focus on nursing care. “I think that the patients are seeking guidance from the people they trust the most,” Martino said. “And the person that they seem to trust most is the nurse that supports a primary care doctor.”
Wydra said Optum is also interested in the quality of the support staff, the patient experience, and making sure things “are running on time.” Keeping things in the community setting is key, he said, because “90% of the care should happen in the physician’s office.”