Interviews

It can be difficult at times for the Florida Health Care Coalition to meet the needs of every stakeholder, but the patient’s best interest is always at the center, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. The organization works with task forces and advisory groups to find solutions that put the patient first.

Children need support from their families to fight obesity, as they lack the tools to change their diet and exercise patterns alone, according to Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital. Getting obesity under control in childhood is key to reducing the risk of negative health outcomes later in life.

Behind the scenes there are a number of advances that Patricia Flatley Brennan, RN, PhD, director of the National Library of Medicine, would like to see take place to make it easier to get literature into people's hands.

Original research is necessary to overcome the challenges inherent in our healthcare system, in part by helping us fully understand various behavioral incentives, said Zirui Song, MD, PhD, resident at Massachusetts General Hospital.

With new technologies that allow insulin to be delivered much more easily and at a targeted speed, diabetes treatment is less likely to interfere with patients’ lives, explained Yehuda Handelsman, MD, FACP, FACE, FNLA, medical director and principal investigator at the Metabolic Institute of America.

Palliative care can help alleviate the suffering and symptoms that go along with serious disease, making it an important component when caring for complex, high-need patients, said Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

In order to develop shared decision-making, physicians must build trusting relationships with patients and be mindful of cultural biases, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center. She also encouraged practices to develop a unified direction to ensure incentives are aligned for the entire care team.

Empathy is the root of dignity for patients, and healthcare providers need to consciously adjust their communication styles to demonstrate that empathy, according to Melissa Thompson, MBA, healthcare strategist, patient, and self-advocate. Some examples include not discussing the patient without including them and using inclusive language that brings the patient and provider together.

According to Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, professor of medicine at the Hofstra Northwell School of Medicine, research on rivaroxaban to prevent thrombosis is moving from determining efficacy to evaluating patient-centered outcomes in a variety of clinical situations, as evidenced by new studies like EINSTEIN-CHOICE and the MARINER trial.

E. Magnus Ohman, MD, FRCPI, FESC, FACC, FSCAI, professor of medicine at Duke University Medical Center, discussed the results of the GEMINI-ACS-1 trial comparing rivaroxaban and aspirin in acute coronary syndrome (ACS), which he and his co-authors presented at the American College of Cardiology 66th Scientific Session. They found no significant differences in the primary endpoints and ischemic outcomes, though further research will be necessary to inform clinical practice.

At the Putting Care at the Center conference, panelists presented their successful models for caring for high-needs patients, which were summarized by Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers. These models provided examples of how to scale up innovative approaches to care delivery and interventions.

There are more costs involved in cancer treatment than just the price of the drugs, said Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health. The process of selecting the right treatment also factors into spending, so it is important for patients to get a second opinion.

The EINSTEIN-CHOICE findings presented at the American College of Cardiology 66th Session demonstrated some promising outcomes, showing that rivaroxaban is a viable option for long-term prevention of venous thromboembolism in some patients, said Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, professor of medicine at the Hofstra Northwell School of Medicine.

A worldwide study of rheumatoid arthritis patients and providers found that they often focus on separate goals, which can lead to a disconnect in communication, according to Allan Gibofsky, MD, professor of medicine and public health at Weill Cornell Medical College and an attending rheumatologist at Hospital for Special Surgery.

If the burden of cost sharing no longer fell on cancer patients, they would be more likely to access care and maintain treatment as prescribed, leading to improved outcomes, according to Samantha Watson, founder and CEO of The Samfund. When faced with high copays, patients are more likely to skip appointments or take only half of their prescribed medications.

The use of biomarkers in immunotherapy has some technical and biological limitations, and is complicated further by the qualitative aspect of cancer treatment, said David Fabrizio, of Foundation Medicine, Inc. A genomic-based solution could help develop more unified quantitative approaches.

Partnering with local nonprofits with expertise in various areas, such as food support, vocational services, and mental health case management, Hennepin Health has been able to successful manage the health of a complex population, explained Ross Owen, health strategy director of Hennepin County.

Oncology physicians and nurses need to listen to their patients’ needs and expectations to determine the right way to present information on cancer treatments, including immuno-oncology, according to Debra L. Madden, cancer research advocate and patient representative.

At the American College of Cardiology 66th Scientific Session, Eric Peterson, MD, professor of medicine in the division of cardiology at Duke University School of Medicine, presented study findings that showed patients discontinued rivaroxaban less frequently than other anticoagulation agents. These results are important, he said, because regardless of what a clinician prescribes, “it’s the drugs that patients take that make the difference.”

The increased emphasis that the Affordable Care Act and Medicare accountable care organizations (ACOs) placed on prevention is important in reducing the high cost of older patients, especially as the baby boomer generation reached retirement age, explained Mariétou Ouayogodé, PhD, post-doctoral fellow at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.

Jonathan Hirsch, founder and president of Syapse, was working to earn a PhD at Stanford when he noticed that physicians needed better software systems in order to successfully implement precision medicine. He then dropped out of graduate school to found Syapse, a health IT company that provides physician-friendly software.

When caring for patients with diabetes, it’s important for providers to take into account the patient’s culture and how it can affect communication styles and treatment preferences, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center.

Advances in technology has had a profound impact on the National Library of Medicine and allows the use of virtual reality to deliver information in new ways to patients, explained Patricia Flatley Brennan, RN, PhD, director of the National Library of Medicine.

The cost of oncology care has increased significantly in recent years, leading employers to worry about how they can provide consistent benefits for employees with cancer and their family members, according to Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.

Patients with obesity often face severe stigmatization from healthcare providers, which can discourage them from seeking help, according to Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital. She explained that the “dismal” obesity education in medical schools can lead physicians to judge obese patients unfairly.

Years of experience as an oncology nurse practitioner have underscored the importance of evidence-based resources for both patients and clinicians, says Carrie Stricker, PhD, RN, AOCN, chief clinical officer and co-founder of Carevive.

When discussing value in oncology, the outcomes that matter are those that are important to the patient, said Stuart Goldberg, MD, chief medical officer, Cancer Outcomes Tracking and Analysis, John Theurer Cancer Center. He also discussed how the use of data to stratify patients is important for providing value-based cancer care.

The main focus of Humana’s business activities is to provide a better experience for patients and physicians, according to Roy Beveridge, MD, chief medical officer of Humana. This patient-centered approach is informed by his work as a practicing oncologist, where he learned to think about clinical programs from the perspective of the patient.

Convenient care clinics like MinuteClinic allow patients without regular primary care to become more informed about their health and medications, according to Kristene Diggins, FAANP, CNE, NEA‐BC, DNP, MBA, manager of professional practice at MinuteClinic.

As healthcare increasingly rewards quality and value in care delivery, Aetna hopes that 75% of its payments will be value-based by 2020, according to Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.