PCOC: Patient-Centered Oncology Care

The evidence shows that chimeric antigen receptor (CAR) T-cell therapies are effective, but the price tags on these treatments are high and have raised concerns about how many patients will get treated. During a discussion at The American Journal of Managed Care®’s Patient-Centered Oncology Care® meeting, held Friday in Philadelphia, panelists outlined the efficacy of the 2 FDA-approved therapies, Medicare reimbursement for CAR T-cell therapies, and the pace of innovation in healthcare.

There are similarities between the challenges of accessing good cancer care in rural areas of the United States and Rwanda, such as poverty, transportation, and lack of routine care, said Lawrence N. Shulman, MD, director of the Center for Global Cancer Medicine at the Abramson Cancer Center, and professor of Medicine at the Hospital of the University of Pennsylvania.

After being treated for his chronic lymphocytic leukemia with chimeric antigen receptor (CAR) T-cell therapy, Brian Koffman, MDCM, DCFP, DABFM, MS Ed, medical director, CLL Society, is being followed for 15 years to better understand if there are any undiscovered adverse events that pop up and how durable the response is.

As patients start chemotherapy to treat their cancer, they are educated on the side effects, particularly neutropenia, said Beth Wittmer, RN, OCN, manager of care management at Florida Cancer Specialists and Research Institute.

In the keynote address at Patient-Centered Oncology Care® 2018, Barbara McAneny, MD, a New Mexico oncologist/hematologist and the current president of the American Medical Association (AMA), shared her diagnosis for the current crisis in US healthcare, as well as a prescription—a new real-time oncology payment model led by physicians.

Since chimeric antigen receptor (CAR) T-cell therapy is still in early development there are benefits and risks that eligible patients will have to weigh, including the durable response against the limited amount of data and toxic side effects, said Brian Koffman, MDCM, DCFP, DABFM, MS Ed, medical director, CLL Society.

At a session of The American Journal of Managed Care®'s Patient-Centered Oncology Care® 2018 meeting, held November 16 in Philadelphia, panelists shared their views on the future of oncology value-based payment models and how they as payers and providers can help advance these models.

As practices shift to value-based care, they need truly coordinated care teams that discuss high-risk patients and identify ways to deliver care to them, said Marcus Neubauer, MD, chief medical officer, US Oncology.

Mark Fleury, PhD, MS, principal of Policy Development and Emerging Science at the American Cancer Society Cancer Action Network (ACS CAN), has highlighted the advocacy efforts the organization was involved in from the local level to the federal level.

The latest version of FDA's patient-focused drug development initiative is trying to gather patient perspectives in a systematic way, but the effort faces the challenge of understanding the spectrum of those perspectives, said Mark Fleury, PhD, MS, principal of Policy Development and Emerging Science at the American Cancer Society Cancer Action Network (ACS CAN).

Only a small percent of patients eligible for assistance programs actually enroll, and Vivor is working with pharmaceutical companies to make the process of using patient assistance programs smoother, said Ian Manners, founder and CEO of Vivor.

The 21st Century Cures Act, in many ways, helps drugs in other disease areas going through review with FDA get to the same standard of the oncology area, said Mark Fleury, PhD, MS, principal of Policy Development and Emerging Science at the American Cancer Society Cancer Action Network (ACS CAN).

Vivor helps patients receive financial assistance by focusing on empowering the providers and making it easier for financial navigators to do their job, said Ian Manners, founder and CEO of Vivor.

Thomas Graf, MD, chief medical officer and vice president, Horizon Blue Cross Blue Shield of New Jersey, discusses evolving care bundle payments to better accommodate cancer patients.

Stacey McCullough, PharmD, senior vice president of pharmacy at Tennessee Oncology, discusses the importance of the pharmacist there are more advances being made and therapeutic options becoming available in oncology.

The more data providers have on a patient, the better understanding they have about the type of treatment plan that works best with the patient’s goals, explained Torrie K. Fields, MPH, senior program manager of Palliative Care Program Design & Implementation for Blue Shield of California.

Thomas Graf, MD, chief medical officer and vice president, Horizon Blue Cross Blue Shield of New Jersey, discusses the impact of new therapies on private insurance coverage for cancer patients.

Committees for Via Oncology meet frequently to update pathway platforms and support the growing needs of physicians, according to Kathleen Lokay.

With more oncology patients receiving oral therapies, the pharmacist plays an important role in patient education and follow-up, said Stacey McCullough, PharmD, senior vice president of pharmacy at Tennessee Oncology.

Each stakeholder (employers, patients, family members, physicians, payers) values the impact of novel therapies differently, said Thomas Graf, MD, chief medical officer and vice president, Horizon Blue Cross Blue Shield of New Jersey.

There still needs to be more education around what real-world evidence is, explained Jason Harris, associate director of policy and programs at National Health Council.

No one wants to think that they can’t afford the treatment, and they certainly don’t want to raise that issue with their physician, said Ian Manners, MBA, co-founder, CEO, Vivor.

Thomas Graf, MD, chief medical officer and vice president, Horizon Blue Cross Blue Shield of New Jersey, discusses the impact of increases in drug prices on oncology stakeholders.

Jason Harris, associate director of policy and programs at National Health Council, talks about promoting high-value, patient-centric care that reduces costs.

Brenton Fargnoli, MD, medical director of value-based care and director of product marketing and strategy at Flatiron Health, addresses the issues electronic health records (EHRs) cause and what Flatiron Health can do to make things more efficient.

Via Oncology is taking several steps to implement value into clinical pathways programs, explained President and CEO Kathleen Lokay.

Jason Harris, associate director of policy and programs at National Health Council, notes the importance of using real-world evidence to support value in payment models.

Brenton Fargnoli, MD, medical director of value-based care and director of product marketing and strategy at Flatiron Health, recognizes the importance of benchmarking to further improvement.

Kathleen Lokay, president and CEO of Via Oncology, encourages physicians to educate patients on clinical pathways and discusses how the patient voice is heard.

Brenton Fargnoli, MD, medical director of value-based care and director of product marketing and strategy at Flatiron Health, predicts the future of the learning health system in the United States.