Interviews

As the shift from volume-based care to value-based care continues, providers will require a whole new mindset and skillset to be successful, according to Katherine Schneider, MD, president of the Delaware Valley ACO.

Data from electronic health records aren’t always helpful for oncologists, which is why the founders of Cancer Outcomes Tracking and Analysis (COTA) developed a platform that stratifies patients by relevant characteristics, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Physicians may have a hard time relinquishing their own piece of the healthcare puzzle, whether due to financial incentives or inadequate care coordination, said Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center.

Oncologists need to ask patients the right questions and truly listen to the answers, but they must then balance the individuals’ goals with the practice’s efforts to provide consistently efficient cancer care to all patients, according to Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network.

Bundled payment models could provide surgeons with a full spectrum of data that can help them decide which hospital is the right choice for their patients, said Andrei Gonzales, MD, McKesson's director of value-based reimbursement initiatives. He also said that this data can drive improvement for hospitals that may be falling behind.

Payers have been slow to adopt new technologies, but they are starting to be more proactive in seeking out genomic profiling companies, according to David Fabrizio, of Foundation Medicine, Inc. These molecular diagnostic tools make the healthcare process more efficient by performing a comprehensive test at the point of diagnosis.

Patients have a number of concerns about insulin, including pain from injections and interference with their activities, said Yehuda Handelsman, MD, FACP, FACE, FNLA, medical director and principal investigator at the Metabolic Institute of America. However, clinicians must play an important role in explaining to patients how recent advances have made insulin delivery simpler and more convenient.

A major goal of the Choosing Wisely campaign is to educate and empower both the clinician and patient communities, eventually reducing the overuse of resources, according to Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation.

The transformation to value-based oncology care must be centered upon the priorities and needs of patients and their families, said Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology. This vision is starting to be incorporated in areas like the Oncology Care Model, which looks at patient-reported outcomes and experiences.

The biggest challenge in moving to value-based care is the mindset of providers accustomed to volume-based care, as they must work with payers to change the systems, said Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

CMS understands that not all physicians will report quality measures under the Medicare Access and CHIP Reauthorization Act or join advanced alternative payment models, especially immediately, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS. However, there are efforts in place to make it as easy as possible for these providers, which will hopefully increase participation over time.

As Cancer & Hematology Centers of Western Michigan starts to participate in the Oncology Care Model (OCM), it has dedicated its resources to understanding the model and analyzing data, said Stuart Genschaw, executive director of the Cancer & Hematology Centers of Western Michigan. Throughout this process, however, the practice’s main focus is always on “providing great care” to its patients.

Cooperation and trust are key in getting partners to work well together as part of a coordinated care organization (CCO), said Christine Bernsten, senior manager of delivery systems transformation for Health Share of Oregon.

Physicians have shown great interest in understanding how to transition into value-based processes, especially with the new rules under the Medicare Access and CHIP Reauthorization Act (MACRA), said Roy Beveridge, MD, chief medical officer of Humana. While these transitions take time and effort, they eventually lead to physicians being reimbursed more for longer visit times and improved outcomes.

David L. Porter, MD, of the University of Pennsylvania Health System, explains why treating tumors with a combination of CAR-T cells and other immune-stimulating agents is a logical next step for investigators.

Many patients have learned about the advances in immunotherapy treatments for cancer, but the media may not be portraying all the complexities and potential harms of these agents, according to Debra L. Madden, cancer research advocate and patient representative. Madden mentioned that biomarker research could help determine which patients are most likely to benefit from immuno-oncology.

Although there are still some unknowns surrounding the new Medicare Advantage Value-Based Insurance Design (VBID) Model, beneficiaries are likely to appreciate the reduction in copays for high-value care, said Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School.

Oncologists must recognize the importance of the patient voice when making treatment decisions so that the treatment plan can be adapted to each patient’s goals and desires, said Carrie Stricker, PhD, RN, AOCN, chief clinical officer and co-founder of Carevive.

The TAPUR clinical trial is rapidly expanding to new sites, but the researchers have not yet collected enough data to analyze and publish the results, according to Pam Mangat, MS, associate director TAPUR study at the American Society of Clinical Oncology.

Fitbit understands the importance of user privacy and only provides data in aggregate to program administrators, said Ben Sommers, MBA, vice president of North America Business Development at Fitbit Wellness.

Gathering patient-reported outcomes and experiences is essential to evaluating the success of bundled payment models, said Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Cancer care and its associated costs can combine with everyday bills to create a significant financial burden, especially for young adults with cancer, said Samantha Watson, founder and CEO of The Samfund.

The new Medicare Advantage value-based insurance design (VBID) demonstration, which is supported by both the Obama administration and the Republican House of Representatives, has sparked interest from additional states that want to be involved in this access-increasing program, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan.

Precision medicine shows great potential in helping patients get personalized interventions for many conditions, said Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

Oncology care is often spread out across multiple facilities and providers, so health IT innovators use software to integrate data from these many locations and deliver it to the point of care, according to Jonathan Hirsch, founder and president of Syapse.

When working with a homeless population, the Camden Coalition has learned that they need to establish open lines of communication, build a sense of trust, and follow through on their promises to patients, according to Renee Murray, associate clinical director of Care Management Initiatives at Camden Coalition. Often times these patients have more urgent priorities or may not believe that the Camden Coalition team is actually dedicated to working with them.

FDA’s regulatory science activities are working to advance the field of precision oncology, in part by using predictive analyses to identify patients that may be good candidates for certain therapies, according to Sean Khozin, MD, MPH, senior medical officer at the FDA.

The kind of data oncologists need to move towards value-based care isn’t easily accessible in patient electronic health records, but new platforms like Cancer Outcomes Tracking and Analysis (COTA) are trying to make it easier, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Until there is more data to support the outcomes of using telemedicine, payers will be more cautious about getting into reimbursing for the technology, said Anne Schmidt, MD, associate medical director at Blue Cross and Blue Shield of Alabama.

Patients will become more actively involved in their healthcare decision making as they become better informed, according to Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council. She also discussed the importance of providing transparency to patients so they fully understand their healthcare choices.