The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.
Tennessee Oncology, based in Nashville, has announced new leadership roles for medical oncologist Stephen Schleicher, MD, MBA, and Natalie Dickson, MD, a medical oncologist/hematologist who most recently served as president and chief medical officer (CMO).
Effective January 1, Schleicher became CMO; Dickson remains president while taking on the new role of chief strategy officer (CSO).
Ron Horowitz remains the CEO, and Jeff Patton, MD, formerly CEO, is board chair. Additionally, Patton is now CEO of OneOncology, a network of community-based oncology practices that wish to maintain independence while partnering to leverage data and technology, clinical pathways, pharmacy and therapeutics, and clinical trial participation.
According to a statement from Tennessee Oncology, Dickson will focus on Tennessee Oncology’s growth and long-term strategy while Schleicher will oversee clinical programs “to promote the high-quality, innovative, and patient-centered care Tennessee Oncology is known for delivering.” The community practice has more than 190 providers across 33 clinics in Tennessee and northern Georgia.
Dickson is credited with facilitating Tennessee Oncology’s entrance into the Oncology Care Model (OCM), creating an internal palliative care program, developing a financial counseling team, and creating integrated oncology and genetics counseling programs. Schleicher, who has served as medical director for value-based care for Tennessee Oncology and OneOncology, received perfect scores in the OCM while saving millions of dollars, secured certification from the American Society of Clinical Oncology (ASCO), and formed one of the largest commercial oncology medical home programs with Ascension and Blue Cross Blue Shield of Tennessee.
Schleicher, who is a member of the Evidence-Based Oncology™ (EBO) editorial board, and Dickson discussed their new roles and upcoming challenges in community oncology. This interview has been edited lightly for clarity.
EBO: Dr Schleicher, can you discuss your new role and responsibilities as CMO at Tennessee Oncology?
Schleicher: In my new role as chief medical officer at Tennessee Oncology, I will continue working very closely with Dr Dixon, who has been our previous chief medical officer and president, and she will remain president [along] with [taking on] her new role, chief strategy officer. Tennessee Oncology has done a great job over the last 5-plus years of making itself [into] a unique, world-class cancer organization in the community. [Much] of that relies on internal maximization of quality, on innovation, and on a drive toward value. My goal is to continue to support that internally and help that grow, so we can continue to be a unique, high-quality, comprehensive service offering in the community. [This] includes a push of innovation toward value; we’ll continue that. It [includes] helping us clinically; to continue top-notch, evidence-based care at all of our 30-plus clinic sites; to continue to support expansion of services, such as psychology, genetics, integrative oncology, and other things that every patient, wherever they may live, needs access to; and to really make sure that all of our clinics can continue to provide that high-quality, comprehensive care. And, we will continue to push innovation, just as Dr Dixon has done in her many years as CMO before this.
EBO: Dr Dickson, similar question: Can you please explain your new role and responsibilities as CSO and how they expand your responsibilities as president?
Dickson: As president, my goal is to enhance a culture that promotes the highest quality of care across our clinical and our ancillary sites, and in this way accomplish our mission. I’m also involved in looking at ways to improve service excellence and patient-centered care, and ensuring that we have the resources for continuous improvement and for innovation. It’s also my role—and it’s really important—to help create a highly attractive practice environment, not just for physicians, but also the staff, and to foster their professional development and their personal well-being. So, in my expanding role as chief strategy officer, I will work closely with our CEO and our executive team to provide strategic and visionary input to advance the transformation of care delivery, and to seek new opportunities for growth. It will be important for me to strengthen our partnerships, to make new relationships, and to identify new processes, technology, and new business opportunities. As Dr Schleicher alluded to just now, so many exciting things are happening at Tennessee Oncology: We have specialized teams working on patient monitoring and patient communication; [we are] expanding our data analytics capabilities, [with] the addition of new technologies to support care coordination; new medical home programs, in partnership with payers; and partnerships with local hospital systems to enhance comprehensive care. [We are] developing clinical trial research through Sarah Cannon Research Institute, a comprehensive precision medicine program, and the steady addition of new clinics. And so, it’s important that my actions and decisions as CSO help bolster these initiatives.
EBO: What are some of the biggest challenges ahead for Tennessee Oncology, specifically, and for community oncology more broadly over the next several years?
Dickson: Government policy changes, as a burden of utilization management, remain our biggest risk and challenge. Government policy changes can have sweeping effects on our reimbursement, such as the recently abandoned “most favored nation” policy and the recent update on the in-office ancillary service exemption. Utilization management—including things like step edits, prior authorization, and formulary control—remain really burdensome for practices, especially practices like ours [that] are already investing in and adhering to evidence-based clinical pathways. So, it’s really important for community oncology to continue to advocate through [the Community Oncology Alliance] and our specialty societies. But we face many more challenges. [Pharmacy benefit managers] are redirecting patients away from in-practice pharmacists, which prevents our patients from benefiting from our practices’ compliance and toxicity monitoring. Obtaining access to real-time patient data is challenging, but it’s really necessary to be able to participate successfully in value-based care programs. And it is critical if a practice is taking on downside risk.
And then, don’t forget the cost of a data warehouse—this is often prohibitive for small practices. Practices are being bombarded by a multitude of technology and service vendors, and it’s hard to evaluate and determine their value. Many practices don’t have the expertise to take this on. Tennessee Oncology is able to leverage the expertise of OneOncology to help in this regard. Of course, there are new players on the market; some offer some level of competition, and others just increase the complexity of the management of our cancer patients—things like infusion centers, or pathology groups that are vying for access to a patient’s tissue. But despite all this, if we remain patient focused, and true to our mission, and engaged in health policy reform, I’m confident that community oncology will weather the storm and the many challenges to vaccine.
EBO: Dr Dickson, OneOncology has been at the forefront of the discussion of the need for 340B reforms to create a fair playing field for community oncology. How have these trends affected Tennessee Oncology? And how have you responded as practice?
Dickson: The 340B program was developed to help patients in need, and especially those patients with cancer. Unfortunately, it has been determined that, by and large, hospitals have not increased their uncompensated care once they’ve entered this 340B program. Tennessee Oncology continues to be the primary provider of free cancer care in our market. And we treat and manage all patients who grace our clinics, regardless of whether they’re insured. We think it’s just the right thing to do. You know, in 2021, we were able to provide more than $70 million in free drug. We see that patients continue to pay very high prices at hospitals, and the prices are much [higher] than in the community setting. What we can do is can continue to advocate for fairer pricing and for price transparency. And we’ll also try to make data available to health policy researchers. We will continue to demonstrate our value, to demonstrate our value proposition to our patients and our communities and health plans and the employers. Our value proposition is that we provide the highest quality of care with the lowest cost for drugs, for radiation, and for imaging for labs; and we also continue to provide cutting-edge clinical research and comprehensive supportive care services for our patients close to their homes. You know, I think it’s in the best interest of patients, health plans, and employers to shift all expensive treatments from the hospital to the community. And if we share our data, and share our experiences, I think [we] may accelerate this transition.
EBO: Let’s transition to the OCM. Dr Schleicher, over the past few years, Tennessee Oncology has seen great success in the OCM, saving Medicare millions of dollars and achieving perfect quality scores. Can you please describe what Tennessee Oncology plans to do after the end of the OCM this summer?
Schleicher: Great question. We’ve learned so much by participating in the OCM—[to start], how to reduce hospitalizations and emergency [department] visits, and how to incorporate pathways into care, to make sure patients get the right care at the right time. We’ve centralized our triage teams; we centralized responding to patient illness and issues in the acute setting. We’ve centralized care coordinators to proactively reach out to patients. So, we’ve done all these things, and it’s helped us learn how to improve quality of care. We know that’s the right thing to do—as Dr Dixon mentioned, our mission is to have the highest quality care possible in the community [while] lowering cost by keeping people out of the hospital, etc. We’ve incorporated palliative care, etc. So, with all these things that we’ve learned from OCM, we have no inclination to stop doing that just because the model ends. We’ll continue to provide these resources to patients. [It’s] great that we’ve learned this, and we’re large enough that we can continue.
We’ve tried to use what we’ve learned and to apply this to the non-Medicare population as well. We’re in one of the largest commercial Oncology Medical Homes in the country through our partnership with Blue Cross Blue Shield, and that’s also partially through Ascension, which we have a partnership with. And we’re in several other medical homes; we’re one of 11 practices to be working toward ASCO Medical Home accreditation. We have no goal to put on the brakes here; instead, [we want to] continue to drive value, which also drives innovation in patient care. Our hope is that Medicare has a follow-up model to the OCM at some point, because just as we learned so much through OCM; we want to continue to learn through future models. We hope that there’s a bridge between models, but not an end to the model for Medicare, because that is such a large patient population. And those enhanced services payments allowed us to build these programs. So, we have every intention to continue doing what we’ve been doing—even broadening [it] to commercial populations. But we do hope that Medicare has an upcoming value-based care model as well, because we’d hate to have learned all these things, and not have a model to apply it to, even though we’ll continue to apply it to our patients.
EBO: Where do you see advances in value-based care going from here? How much leadership will come from Medicare, and how much innovation is happening in the commercial sector?
Schleicher: Medicare obviously was extremely influential in teaching us about value-based care in oncology through the OCM. Oncology is very different from other types of specialty care, especially primary care, because within cancer are [more than] 100 different diseases. Every patient is different—how do you account for that? Drugs, unfortunately, whether we like it or not, are the elephant in the room—drugs make up a huge part of the cost. So how does that go into a model?
We’re really, really incentivized to keep people out of the hospital. Yet, [for example], Keytruda [pembrolizumab], one of the best drugs we have, is still very expensive. How do we balance all that? So, Medicare has taught us a lot.
Now, as OCM is ending—and hopefully [it represents] just a bridge toward something else for Medicare—I really applaud our commercial payers. At least in Tennessee, I can speak of [several] that have come to us either with attempts to co-create models, or bring value-based care models to us, largely stemming from the OCM. But our hope is to make each model that much more innovative, so that we can continue to drive value, even in the absence of a Medicare model right now.
Some real pluses—with commercial payers, it’s obviously very different. For large practice, if you’re talking to a large commercial payer, like Blue Cross, we just co-created a medical home with them. [After] being one of 180 practices talking to Medicare about OCM, now we really get a chance to co-design models, which is excellent, because it allows us to take what we’ve learned from being participants in a 5- or 6-year government pilot and apply that to a more nuanced model that fits our patient population—and really align where costs are and what we can actually control. A big plus with commercial [payers] is the ability to co-create.
Two, there’s data sharing, which is a problem with OCM. As I understand it, [with the OCM] after 18 months, you get the full reconciliation report and know how you did. With commercial models, where it’s just 1 big practice and 1 large commercial payer, we’re able to share data much more quickly and get feedback to drive innovation much faster than an 18-month PDSA [plan, do, study, act] cycle. So, that’s another big plus.
And then third, it expands the population who gets access to these great services that we’ve begun to offer through OCM. Now, we’re able to apply it across broader patient populations; more patients benefit. Something else that comes up a lot is health care disparities, and we’ve found that a lot of what we’ve learned and created in response to OCM disproportionately impact patients who live in rural areas. By engaging through [patient-reported outcomes], our care navigators, and our coordinators, [we’ve reached] a large population of these patients who live 30 miles outside of metropolitan areas; to be being able to take those great benefits and apply [them] to the large commercial population is another big win. … As we wait for the next model, a lot of innovations are happening with commercial payers, and it’s a great extension from what we learned from OCM. Hopefully, we continue to innovate even faster, and bring that back to the Medicare population when the next model comes.