Interviews

Novel therapies come with high costs, but they have the potential to more effectively treat some patients, and employers are struggling to handle the cost burden of them, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Providing access to complex therapies through the Medicare market can benefit patients who are disproportionately ignored by socioeconomic status, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

The only thing that should matter in these patients is their genetic code, but often it’s your zip code that really restrains your ability to access the healthcare you deserve, explained Ahmar Zaidi, MD, pediatric hematologist-oncologist, Comprehensive Sickle Cell Center, Children's Hospital of Michigan, when discussing the possibility of a gene therapy for sickle cell.

Since the introduction of disease-modifying therapies for multiple sclerosis (MS), evidence from disease registries has shown how the therapies work in the real world and reduce the effect of MS on people’s lives, according to Daniel Kantor, MD, president of Kantor Neurology.

Lani M. Alison, BSN, MS, HCQ, PCMH, CCE, vice president of Clinical Affairs, Regional Cancer Care Associates, explains how the implementation of the Oncology Care Model (OCM) allowed practices to better integrate palliative care.

Albert Rizzo, MD, FACP, chief medical officer for the American Lung Association, discusses the prevalence of overtreatment and undertreatment in chronic obstructive pulmonary disease (COPD).

Real-world outcomes are important because the populations included in clinical trials rarely reflect the populations actually being treated in the clinic, said Ajai Chari, MD, associate professor of medicine, Hematology and Medical Oncology, Mount Sinai Hospital.

Innovation that transform cancer care delivery have to be multi-level, explained Iuliana Shapira, MD, chief medical officer, Regional Cancer Care Associates.

Using imaging, laboratory testing, and predictive models, the field of multiple sclerosis (MS) is getting closer to predicting the course of MS and, eventually, the best medication for a given patient, said Daniel Kantor, MD, president of Kantor Neurology.

Employers have become more aware of how key an issue mental health is for employees and they are relieving some of the perceived stigma by making it okay to talk about mental health issues, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

John Fox, MD, MHA, vice president of Clinical Transformation at Spectrum Health, discusses management challenges still facing providers treating multiple myeloma.

The field of treatments for multiple sclerosis (MS) has grown quickly in the last 30 years, but the next new class of therapies probably won’t come to market for at least another year and a half, said Daniel Kantor, MD, president of Kantor Neurology.

Neil Minkoff, MD, chief medical officer and vice president, EmpiraMed, discusses his hopes if the first gene therapy for sickle cell disease is approved and if he has any concerns with payer reactions.

Lani M. Alison, BSN, MS, HCQ, PCMH, CCE, vice president of Clinical Affairs, Regional Cancer Care Associates, explains the questions that patients have about oncology care pathways and treatment guidelines.

Currently, employers choose health plans based on administrative costs and provider discounts, but they need to start engaging around value-based reimbursement, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Offering patients genetic counseling before and after they receive genetic testing is crucial for making sure they understand what the results mean, explained John Fox, MD, MHA, vice president of Clinical Transformation at Spectrum Health.

The cost of radiation oncology services has typically been a small part of the Medicare and Medicaid budget, but with more patients having complex radiation treatments, it is becoming more important to have alternative payment models in the space, said Shalom Kalnicki, MD, FASTRO, FACRO, professor and chairman, radiation oncology, Montefiore Einstein Center for Cancer Care and Albert Einstein College of Medicine.

Albert Rizzo, MD, FACP, chief medical officer for the American Lung Association, offers his thoughts on the FDA's recent proposal to require health warnings with images on cigarette packages.

Monoclonal gammopathy of undetermined significance is a diagnosis of exclusion, but even once it has been identified, patients should not obsess over this precancerous condition, said Ajai Chari, MD, associate professor of medicine, Hematology and Medical Oncology, Mount Sinai Hospital.

With an increase in the use of 3- and 4-drug regimens in multiple myeloma, providers are going to need to communicate the out-of-pocket costs when presenting treatment options so that patients can make an informed decision, explained John Fox, MD, MHA, vice president of Clinical Transformation at Spectrum Health.

Ahmar Zaidi, MD, pediatric hematologist-oncologist, Comprehensive Sickle Cell Center, Children's Hospital of Michigan, discusses the need for more efforts from both the medical community and regulators to address the psychosocial complications of sickle cell disease.

Employers are looking for ways to advocate for their employees and invest in places that will reduce downstream costs, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Understanding patient-reported outcomes in disease states enhances our ability to provide patients with better care and an increased quality of life, said Patty Taddei-Allen, PharmD, MBA, BCACP, BCGP, director of outcomes research, WelldyneRx.

Iuliana Shapira, MD, chief medical officer, Regional Cancer Care Associates (RCCA), discusses how RCCA is managing the higher costs of immuno-oncology drugs in value-based care.

Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative, discusses challenges with incorporating more novel concepts of value into value assessment.

When seniors with cancer are being treated with combination therapies, providers need to keep in mind more than just the complex regimens they’re administering, said Ginah Nightingale, PharmD, associate professor of pharmacy practice at Jefferson College of Pharmacy.

Research has shown disparities in multiple myeloma treatment between clinical trials and real-world outcomes, as well as a lot of heterogeneity among treatment patterns by age and region, said Ajai Chari, MD, associate professor of medicine, Hematology and Medical Oncology, Mount Sinai Hospital.

Albert Rizzo, MD, FACP, chief medical officer for the American Lung Association, discusses the use of forced expiratory volume in 1 second (FEV1) /forced vital capacity (FVC) for the diagnosis of chronic obstructive pulmonary disease.

The Consortium of Multiple Sclerosis (MS) Centers is unique in that it places physicians and other healthcare professionals on a level playing field while elevating the patient’s voice to be the most important on the team, explained June Halper, MSN, APN-C, MSCN, FAAN, chief executive officer, Consortium of Multiple Sclerosis Centers.

Traditionally, migraine is thought of as an issue of lost productivity, but there is evidence that there are direct costs on the medical claims side, said Neil Goldfarb, president and chief executive officer of the Greater Philadelphia Business Group on Health.