Top 5 Developments and Concerns of Community Oncology Practices

Reimbursement models, novel gene therapy–based treatments, and price transparency: these were some of the topics covered by presenters and panelists at the annual meeting of the Community Oncology Alliance.

The Community Oncology Alliance (COA) hosted its annual meeting April 12-13, 2018, in National Harbor, Maryland. The meeting, which brings together stakeholders from across oncology, delved into overcoming the challenges with patient care that community oncology practices face on a daily basis.

Here are highlights from some of the discussions at the meeting:

1. A deeper dive into MIPS. Two experts from Avalere Health walked the oncology caregivers gathered at COA through the reimbursement programs offered by CMS. Caroline Pearson explained that the primary objective is to reduce costs while simultaneously ensuring high-quality care. Incentives, in her opinion, are a helpful way to push adoption. Despite incentives, physician participation in advanced alternate payment models (A-APMs) remains low: “CMS predicts that 75% of clinicians will participate in the Merit-based Incentive Payment program and 25% will be a part of an A-APM in 2018,” Pearson said.

Pearson’s colleague, Richard Kane, spoke about the 5-year voluntary pilot specifically developed for oncology practices: the Oncology Care Model (OCM), and informed the audience to be on the lookout for the next iteration of OCM.

2. CAR T-cell therapies in the community. Chimeric antigen receptor (CAR)-T cell therapies have been gaining strides and community practices are eager to bring this gene therapy to their patients. At the annual meeting, Houston Holmes, MD, MBA, FACP, Texas Oncology, shared his experience with administering CAR T cells in a community cancer center—based setting.

Presenting the amazing response documented among patients with B-cell acute lymphoblastic leukemia (ALL) who were administered Novartis’ tisagenlecleucel (Kymriah), overall survival a year out was 76%. However, Holmes warned the audience about the toxicities associated with CAR T-cell treatments. Along with a team based program—with participation of the pharmacy, toxicity management, nursing services, social work, and consultant support—the clinic will need a Risk Evaluation and Mitigation Strategy, Holmes said.

3. Cancer pain management in patients and survivors. While pain control in cancer patients often is a priority to ensure the patient is comfortable during treatment, pain control in cancer survivors has gained significant attention of late, according to Bob Twillman, PhD, executive director for the Academy of Integrative Pain Management. Speaking with The American Journal of Managed Care® (AJMC®), Twillman said that growing rate of cancer survivors means that the goals of care have shifted.

“Now that most patients are actually surviving their cancer experience, we have to look at what’s going to be the best for the long term. So, we do have to pay greater attention to issues related to substance use disorder,” he told AJMC®.

Twillman emphasized the importance of paying greater attention to the patients who may be predisposed to addiction, while at the same time ensuring that generalized pull-back in prescribing is avoided.

4. The employer periscope on cost. Oncology remains a high-spending indication for employers, and consultants are advising them on ways to save on costs by analyzing the value of care and site-of-care differences. John Robinson, president, chief executive officer, RobinsonBush, narrated his experience of interacting directly with the employees of his client, which helped shine light on certain gaps—in communication as well as in clinical care—that his organization then decided to tackle.

According to Jeffrey Vacirca, MD, FACP, who heads NY Cancer & Blood Specialists, keeping payers aligned and informed on cost-saving programs is vital for their success. “It’s gratifying to work with payers who are aligned with us on this,” he said.

5. Transparency around drug pricing. “The biggest problem that you have with a lack of transparency is that the list price of the drugs keep on increasing, even though the net prices in some cases are decreasing dramatically,” COA’s executive director, Ted Okon, said during a conversation with AJMC®. The huge divergence in the list price and the net price of drugs, and in the bargain, the patients end up paying more from their pockets, because “they are paying their share of that list price as well as the insurer,” Okon said.

Early last year, COA commissioned a report that took a deeper dive into direct and indirect remuneration of DIR fees administered by pharmacy benefit managers (PBMs) and their impact on drug prices for Medicare Part D beneficiaries and taxpayers. CMS implemented the concept of DIR fees as a way for PBMs to report all rebates received from manufacturers so the true cost of the drug could be known, under Medicare Part D. The report claims that PBMs now use different terms for these fees so they don’t have to report them back to CMS.

The result, according to Okon: “This divergence between the list price and the net price, [is] fueling drug prices.”

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