Innovating Cancer Care in a Changing Landscape
2012 Conference Proceedings
Key Takeaway
In the midst of uncertainty about the future of the Affordable Care Act, leading hospital systems, integrated systems, health plans, and oncology centers and practices are continuing their efforts toward payment and delivery reform to meet cost and quality challenges.
Continuing the Conversation
- According to Dr. Sprandio, improving quality outcomes and reducing unnecessary utilization go hand in hand and are the focus of his organization's oncology patient-centered medical home (PCMH) model. The program also focuses on increasing patient access, improving patient experience, enhancing care coordination, and decreasing unwarranted variation
- The West Clinic is among five oncology groups collaborating with UnitedHealthcare on a pilot program that utilizes episode-based payment for cancer care
- Based on the success of its clinical PATHWAYS program, University of Pittsburgh Medical Center (UPMC) Cancer Centers is working to expand availability of the program throughout the network
- BlueCross BlueShield of Tennessee has been working with practices across the state to establish PCMHs, bundled payment models and accountable care organizations
Key Takeaway
In the midst of uncertainty about the future of the Affordable Care Act, leading hospital systems, integrated systems, health plans, and oncology centers and practices are continuing their efforts toward payment and delivery reform to meet cost and quality challenges.
Continuing the Conversation
- According to Dr. Sprandio, improving quality outcomes and reducing unnecessary utilization go hand in hand and are the focus of his organization's oncology patient-centered medical home (PCMH) model. The program also focuses on increasing patient access, improving patient experience, enhancing care coordination, and decreasing unwarranted variation
- The West Clinic is among five oncology groups collaborating with UnitedHealthcare on a pilot program that utilizes episode-based payment for cancer care
- Based on the success of its clinical PATHWAYS program, University of Pittsburgh Medical Center (UPMC) Cancer Centers is working to expand availability of the program throughout the network
- BlueCross BlueShield of Tennessee has been working with practices across the state to establish PCMHs, bundled payment models and accountable care organizations
Key Takeaway
Employers should have a seat at the table to ensure that their perspectives on value in cancer care are heard.
Continuing the Conversation
- Oncology has become a top area of concern for employers in terms of medical, pharmacy and indirect costs. They are looking closely at value and the quality of innovative services and treatment options
- From a payer perspective, employers are one of the key drivers in the survival of new payment and delivery initiatives and are ready to be innovative, said Dr. Lundquist. “They want to know who the best quality providers out there are, and, who does it most cost effectively. And they're ready to move patients, wherever that may be, if it's cost effective”
- There has been increasing interest by employers to move into the oncology realm to identify value propositions such as primary (e.g., education) and secondary (e.g., screening) prevention programs
Key Takeaway
Suggested as a strategy in health care reform, comparative effectiveness research (CER) holds promise for achieving value in oncology care.
Continuing the Conversation
- According to Dr. McClellan, as additional clinical research data is gathered and analyzed, the CER arena will become increasingly significant to the oncology field, with great potential for improving health care quality while controlling rising costs
- CER can be informative for all stakeholders, noted Dr. McClellan, particularly in the areas of prevention, chronic disease management, care coordination, patient-focused support, and personalized medicine
Key Takeaway
There has been increasing interest in the study of treatment effect heterogeneity and its impact on patient-centered, individualized care.
Continuing the Conversation
- The Patient-Centered Outcomes Research Institute (PCORI) will address potential solutions for assessing treatment heterogeneity in observational and randomized CER studies
- According to Dr. Schwartzberg, The West Clinic is currently assessing evidence of heterogeneous treatment effects in the care of patients with breast cancer
Key Takeaway
The oncology research community is starting to gain a more broadly based understanding of personalized medicine, which, as Dr. Mellman pointed out, has potential to improve not only the quality but also the cost-effectiveness of cancer care.
Continuing the Conversation
- One of the ways Genentech is working towards advancing personalized medicine is through research involving drug resistance, tumor heterogeneity and immunotherapy
- "Done well," said Dr. Mukherjee, "the personalized medicine model will result in treatments that work across not just one patient but multiple patients"
- "Even amid current economic pressures" noted Dr. McClellan, "the potential of personalized medicine to lower health care costs and deliver better outcomes makes it an investment worth considering"
Key Takeaway
The oncology research community is starting to gain a more broadly based understanding of personalized medicine, which, as Dr. Mellman pointed out, has potential to improve not only the quality but also the cost-effectiveness of cancer care.
Continuing the Conversation
- One of the ways Genentech is working towards advancing personalized medicine is through research involving drug resistance, tumor heterogeneity and immunotherapy
- "Done well," said Dr. Mukherjee, "the personalized medicine model will result in treatments that work across not just one patient but multiple patients"
- "Even amid current economic pressures" noted Dr. McClellan, "the potential of personalized medicine to lower health care costs and deliver better outcomes makes it an investment worth considering"
Key Takeaway
Patient involvement is a critical component of successful innovation in oncology care and offers potential benefits to all stakeholders.
Continuing the Conversation
- Dr. Mukherjee's noted distinction between clinical trials on patients and clinical trials with patients signals a future of collaborative partnerships between health care providers, patients and families
- The Patient-Center Outcomes Research Institute (PCORI) is funding several initiatives that will focus on how to improve methods for engaging patients in the Institute's research, including involving patients directly in collecting data, setting research agendas and developing quantitative tools and methods
- According to Dr. Lundquist, patients and/or patient advocates can be beneficial in the clinical trial development process, for example, by helping to identify appropriate endpoints or outcomes that are considered relevant by patients and family members
- The concept of patient-centeredness should extend to include end-of-life care, added Dr. Lundquist. There may be opportunities here to enhance information that would support decision making around this issue
Key Takeaway
Patient involvement is a critical component of successful innovation in oncology care and offers potential benefits to all stakeholders.
Continuing the Conversation
- Dr. Mukherjee's noted distinction between clinical trials on patients and clinical trials with patients signals a future of collaborative partnerships between health care providers, patients and families
- The Patient-Center Outcomes Research Institute (PCORI) is funding several initiatives that will focus on how to improve methods for engaging patients in the Institute's research, including involving patients directly in collecting data, setting research agendas and developing quantitative tools and methods
- According to Dr. Lundquist, patients and/or patient advocates can be beneficial in the clinical trial development process, for example, by helping to identify appropriate endpoints or outcomes that are considered relevant by patients and family members
- The concept of patient-centeredness should extend to include end-of-life care, added Dr. Lundquist. There may be opportunities here to enhance information that would support decision making around this issue
Key Takeaway
Patient involvement is a critical component of successful innovation in oncology care and offers potential benefits to all stakeholders.
Continuing the Conversation
- Dr. Mukherjee's noted distinction between clinical trials on patients and clinical trials with patients signals a future of collaborative partnerships between health care providers, patients and families
- The Patient-Center Outcomes Research Institute (PCORI) is funding several initiatives that will focus on how to improve methods for engaging patients in the Institute's research, including involving patients directly in collecting data, setting research agendas and developing quantitative tools and methods
- According to Dr. Lundquist, patients and/or patient advocates can be beneficial in the clinical trial development process, for example, by helping to identify appropriate endpoints or outcomes that are considered relevant by patients and family members
- The concept of patient-centeredness should extend to include end-of-life care, added Dr. Lundquist. There may be opportunities here to enhance information that would support decision making around this issue
Key Takeaway
Stakeholder groups agree that a broader adoption of information technology (IT) and decision support tools is a critical factor in their efforts to enhance quality, efficiency and transparency in cancer care.
Continuing the Conversation
- Dr. Klein believes that value-based insurance design is one area where clinical decision support tools are needed by providers to help explain treatment option pros and cons objectively to patients
- According to Dr. Klein, it is the role of stakeholders to create a "data highway" that supports the exchange of health information and can be leveraged for comparative effectiveness research and future innovation
- Successful implementation of a value-based pricing system requires, among other actions, establishing electronic exchange of health information to capture patient data in order to better understand the value of new drugs. According to Ms. Jeffords, Genentech is very interested in value-based pricing but lacks the data. There is potential opportunity for stakeholders to work together and innovate in their approaches to gather this data
- Indiana University Health is looking for ways to better leverage their technology (CPOE, e-prescribing, electronic health records, robust data warehouse for research and individual clinical decision making) in order to provide better tools to manage patients across the whole continuum of care
- Panelists seemed interested in the suggestion that an infrastructure be created to allow for transparency in the pricing of cancer drugs as there is with non-cancer drugs
Key Takeaway
Focusing on enhancement in cancer care coordination, including evidence-based care and best practices, is key to achieving better outcomes at a lower cost, as highlighted by Dr. McClellan.
Continuing the Conversation
- “Cancer treatment is a team approach and patients want to feel that,” said Dr. Levy. They also want family involved in their treatment, and, importantly, they want to hear a consistent message from all of their different providers
- The rise in the number of cancer patients coupled with decreasing reimbursement will require an increasing dependency on a multidisciplinary team approach, with more mid-level providers and nurses involved in the delivery of care
- Cancer survivorship is a challenge for primary care physicians (PCPs), as many lack the adequate training, data, and/or practice standards to guide this type of care. There is an opportunity here to provide the tools and education necessary to improve the continuity and coordination of care for cancer survivors throughout their lives
Key Takeaway
Focusing on enhancement in cancer care coordination, including evidence-based care and best practices, is key to achieving better outcomes at a lower cost, as highlighted by Dr. McClellan.
Continuing the Conversation
- “Cancer treatment is a team approach and patients want to feel that,” said Dr. Levy. They also want family involved in their treatment, and, importantly, they want to hear a consistent message from all of their different providers
- The rise in the number of cancer patients coupled with decreasing reimbursement will require an increasing dependency on a multidisciplinary team approach, with more mid-level providers and nurses involved in the delivery of care
- Cancer survivorship is a challenge for primary care physicians (PCPs), as many lack the adequate training, data, and/or practice standards to guide this type of care. There is an opportunity here to provide the tools and education necessary to improve the continuity and coordination of care for cancer survivors throughout their lives
Key Takeaway
In sum, the key takeaways from the conference illustrate the high hopes, along with the major challenges and uncertainties, for the future of cancer care in this country. According to Dr. Levy, efforts to move from our complex, fragmented care delivery system into one that is integrated, coordinated and cohesive must be transformational in order to be successful. And, as all of the participants agreed, this will require the willingness and readiness of all stakeholders and decision makers to work together to develop and implement innovations designed to reduce costs and improve the quality of care.
