Interviews

An analysis of Medicare accountable care organizations (ACOs) revealed that those with more primary care physicians performed better on preventive care quality measures and infrastructure and financing were also predictive of better performance, 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.

Oncology care management helps coordinate the clinical aspects of cancer treatment, but it would also be helpful to have a benefits manager to help guide patients through their many options, said Marianne Fazen, PhD, president and CEO of the Texas Business Group on Health.

At the PAN Foundation Cost-Sharing Roundtable, a variety of voices were represented from across healthcare to discuss the importance of the safety net, explained Daniel J. Klein, president and CEO of the Patient Access Network (PAN) Foundation.

Before Allison Silvers became vice president of payment and policy at the Center to Advance Palliative Care, she ran an information center that helped the elderly. In both of these roles, she has helped people make the best possible choices after evaluating all of their options.

CAR-T cell treatment can have a number of side effects, with the most serious being cytokine release syndrome, according to David L. Porter, MD, of the University of Pennsylvania Health System. However, there are some promising therapies like interleukin-6 blockers that can reverse this reaction.

Faced with an overwhelming amount of healthcare settings and information, patients with diabetes could find that digital health tools are a powerful resource for managing their illness, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center.

Providers have a responsibility to discuss the costs of cancer care with their patients earlier on, so the patients aren’t blindsided by enormous bills, said Samantha Watson, founder and CEO of The Samfund. These conversations would help patients prepare for the financial realities associated with cancer.

As more organizations begin to issue guidelines for the treatment of rheumatoid arthritis, they will incorporate recommendations to determine whether a drug is working. One option that can help give effective care and streamline patient managements is the use of the Vectra DA test, explained Grace C. Wright, MD, PhD, clinical associate professor of medicine and attending rheumatologist at New York University Langone Medical Center.

Aetna is in the process of transforming from a traditional health insurance company to becoming a healthcare-focused company, in part by emphasizing value-based reimbursement and social determinants of health, said Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

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.