Latest Conference Articles

There remain issues with benchmarking, attribution, and risk adjustment that CMS needs to address with accountable care organizations (ACOs), said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.

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.

Mergers and acquisitions are occurring in response to a change environment where organizations are trying to deliver a more comprehensive service, explained Dan Mendelson, MPP, founder, Avalere Health.

Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts, provides an update on recently approved speciality medications and which we will likely see approved in the remaining months of 2018.

The shorter timeline to risk and the reduction of shared savings rates are among the 2 greatest challenges accountable care organizations (ACOs) will face as part of the proposed changes to the Medicare Shared Savings Program (MSSP), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.

While the proposed changes to the Medicare Shared Savings Program (MSSP) won’t mean a large number of changes to Coastal Carolina Quality Care, the accountable care organization will have to make some changes to respond to the new Enhanced track, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology, discusses how curative, high-cost therapies will impact patient out-of-pocket (OOP) costs and cost sharing.

Thorvardur Halfdanarson, MD, associate professor of medicine and consultant in medical oncology, Mayo Clinic, discusses improvements in diagnostics for neuroendocrine tumors, as well as what improvements are still needed.

The proposed changes to the Medicare Shared Savings Program could prevent the program from driving broad change to value-based care across the country, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.

Somatostatins have been the most game-changing drug in the treatment landscape of gastroenteropancreatic neuroendocrine tumors, explained Scott Paulson, MD, co-director of the Gastrointestinal Research Program for The US Oncology Network, medical director for the Neuroendocrine Research and Treatment Center at Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center.

One of the big issues that policy makers need to pay more attention to is how to reform Medicare, which has about 10 years remaining until the baby boomers aging into the program now start to see increased medical costs and needs, said Joe Antos, PhD, the Wilson H. Taylor Resident Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

To speak about the success and continued development of Priority Health's payment reform model in cancer care, John Fox, MD, medical director at Priority Health, joined Dennis Zoet, chief business development officer at Cancer and Hematology Centers of Western Michigan, on a panel at the Community Oncology Alliance Payer Exchange Summit.

Heloisa Soares, MD, assistant professor, University of New Mexico Cancer Center-Albuquerque, outlines current barriers to achieving positive outcomes in neuroendocrine tumors (NETs) and what's in store for the future.

I’ve seen one case recently where a patient received $172,000 of drugs that were totally wasted. So, we’re going to be looking at this, we’re going to be looking at these middlemen getting in the way of the patient and the physician making a decision about their therapy, explained Ted Okon, executive director of COA.

Looking at total cost of care is difficult and figuring out what the practice is responsible for and not responsible for can be very difficult to do, said Lalan Wilfong, MD, executive vice president of Quality Programs at Texas Oncology.

A patient has their own set of values, providers have their own set of values, and the people that pay for it have their own set of values. So, [we all need to] come together, explains Bo Gamble, Director Of Strategic Practice Initiatives at the Community Oncology Alliance.

At the Community Oncology Alliance Payer Exchange Summit, healthcare policy experts from a government relations firm and from the pharmaceutical industry provided an update on the progress with value-based agreements and also discussed the challenges posed by the existing infrastructure and operational framework.

There are different ways to measure how Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) have saved money, and the way used can drastically affect the amount of savings reported, explained Clif Gaus, ScD, president and CEO of the National Association of ACOs.

I’m not quite certain that the system is equipped to provide a comfort level for clinicians that they’re ready to take on two-sided risk, explained Lyn Fitzgerald, senior vice president, US & Global Development at the National Comprehensive Cancer Network (NCCN).

We've noticed that all of these transformation activities– care transformation, quality improvement, are all actually working, explained Kavita Patel, MD, MS, non-resident senior fellow at the Brookings Institution.

"The cost of cancer care is rising dramatically," said Lalan Wilfong, MD, executive vice president of quality programs at Texas Oncology.

Systems, groups, and practices that haven’t yet joined the accountable care organization (ACO) movement will find it harder to do so if the proposed changes to the Medicare Shared Savings Program (MSSP) take effect, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.

The Community Oncology Alliance (COA) has been working with its member practices and some payer partners who have successfully implemented innovative care delivery and payment models to develop a 2.0 version of CMS’ Oncology Care Model (OCM). A progress report was presented at COA’s Payer Exchange Summit held October 29-30 in Tyson’s Corner, Virginia.

While practice transformation is vital, community-based clinics continue to struggle with emergency department (ED) use, hospitalization, and risk stratification as they identify ways to reduce unnecessary expenditures within their Oncology Care Model (OCM) practice.

Medications for autism spectrum disorder should not replace an effective behavior plan, according to a presentation at Psych Congress 2018. A psychiatrist with 2 twin brothers with the disorder, as well as a daughter, shared her experiences in a presentation called “My Personal and Professional Journey Through Autism: Update on Autism Treatment Through the Lifespan.”

Patient and family engagement is important for ensuring positive clinical outcomes in schizophrenia, which can affect a patient's insight and judgement, explained John Kane, MD, professor and chairman, department of psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital.

There are challenges with diagnosing attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder because of overlapping symptoms, explained Michael First, MD, professor of clinical psychiatry, Columbia University New York State Psychiatric Institute.

Some of the proposed changes to the Medicare Shared Savings Program align with things the National Association of ACOs had been asking for, said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.