A Rapid-Fire Look at How Pharma, Practices Are Embracing Oncology Reform

How is oncology care transformation happening across the country? Based on the opening presentation at this year’s Community Oncology Alliance (COA) Payer Exchange, it’s certainly not “one size fits all.”

The October 25, 2021, session, billed as a “rapid-fire review” of the state
of oncology reform, off ered snapshots of strides that practices and pharmaceutical companies are making in pursuing value-based payment arrangements and patient-centered services, such as steps to keep people out of the emergency department (ED).

COA invited practices and partners to submit highlights of their reform eff orts, which were then shared in a presentation moderated by Bo Gamble, COA’s director of Strategic Practice Initiatives. Joining Gamble were Michael Diaz, MD, director of patient advocacy and assistant managing physician, Florida Cancer Specialists & Research Institute; and Lalan Wilfong, MD, who recently became vice president, Payer Relations and Practice Transformation, for McKesson Specialty Health after several years of working on quality initiatives with Texas Oncology.

PHARMACEUTICAL MANUFACTURERS. Reform examples from pharmaceutical companies included Epizyme’s patient assistance programs. In one, patients who are waiting for insurance approvals can receive temporary cost-free drug supply, and in another, patients with commercial insurance receive co-pay support such that the patient pays no more than $10. Epizyme recently received FDA’s Fast Track designation for its first-in-class oral SETD2 inhibitor, which is being studied in adult patients with relapsed or refractory diff use large B-cell lymphoma.

Novartis shared news about a program to loan electrocardiogram devices to
providers who are administering ribociclib (Kisquali), a drug to treat metastatic breast cancer that inhibits cyclin D1/CDK4 and CDK6. The therapy requires patient monitoring for cardiac effects.

ONCOLOGY PRACTICES. Examples demonstrated a range of strategies. For example, Northwest Medical Specialties, with several locations in Washington state, touted 4 value-based contracts and 2-sided risk participation in the Oncology Care Model (OCM); and‡Tennessee Oncology and its network, OneOncology, pursued an 18-month payer-provider collaboration with BlueCross BlueShield of Tennessee. Authors said it “incorporated best-of-breed aspects of prior oncology payment model pilots.”

Gamble paused when presenting the slides from Hematology-Oncology Associates (HOA) of Central New York. At first glance, the slides seemed to refl ect poorly on the number of hospice days at end of life relative to OCM practices—but a closer look at the data showed there was more than first met the eye.

After COA leaders talked to practice representatives, Gamble said the data showed how the practice was struggling to get hospice services in the area, yet despite this, HOA’s support services helped control chemotherapy costs at end of life. HOA’s average chemotherapy costs in the final 14 days totaled $9817, compared with $18,619 for the OCM overall.

The lesson we learned is that, sometimes, there’s more information behind a measure than just a measure itself,” Gamble said. HOA’s work to overcome obstacles “is certainly showing up.”

REDUCING INPATIENT STAYS. Wilfong presented information from the Center for Cancer and Blood Disorders, based in Fort Worth, Texas, showing the results of an effort for the practice to gain real-time notice when a patient visited the ED. This effort allowed the practice to intervene and reduce hospital stays, with a dispatch system allowing patients to get more direct assistance at home. “They’ve done a lot of great work in this space,” Wilfong said.

The US Oncology Network, with 14 practices in the OCM, has a total of 18
practices participating in 49 commercial value-based contracts across 24 programs.

One of these practices, Minnesota Oncology, is involved in 14 different value-based programs, plus the Merit-based Incentive Payment System. Drilling into the data allowed OHC Specialists in Cancer and Blood Disorders of Ohio to uncover the mystery behind midday ED visits. Patient satisfaction
responses showed that people could not get through on the practice’s phone system—or were not receiving returned phone calls—and were heading to the ED despite instructions to contact the practice. Fixing the communications issue allowed the practice to cut down on their patients’ unnecessary ED visits.

TWO MODELS AT ONCE. Diaz presented information from Blue Ridge Cancer Care, which participates in 2 governmental value programs: the OCM and a Virginia Medicaid episode-of-care pilot. The practice also takes part in the Oncology Medical Home through the American Society of Clinical Oncology. “They attempt to lower costs for all payers as result,” Diaz said. “This is all being accomplished with transparency and closer collaboration with hospice entities and attention to the well-being of patients.”

REDUCING ADMINISTRATIVE BURDENS. Wilfong presented data on Texas Oncology, which is pursuing direct employer arrangements and has seen a reduction of $139.5 million in drug costs through use of biosimilars and a bone health initiative. Additionally, Texas Oncology’s gold carding program, a prior authorization initiative under a new state law, allows physicians with good track records to reduce delays when they adhere to 6 specific pathways regimens. “Hopefully, that [initiative] will expand,” Wilfong said. It grew out of discussions in which payers and providers agreed that some standard, evidence-based regimens shouldn’t require prior authorization.

“Everybody would agree that these things are beneficial for patients—so let’s reduce some administrative burden on the practice and the payer to move things forward,” explained Wilfong.

EVOLVING FROM THE OCM. Diaz then discussed his own practice, Florida Cancer Specialists, in which more than 70% of the lives are being managed in a value-based model.

“A lot of this evolved from participating in the OCM,” Diaz said, but the lessons of earning shared saving and reducing unplanned admissions and ED visits have migrated beyond Medicare to commercial and employer-based contracts, allowing the practice to control increasing cancer care costs.

As you can see, [we have] a whole list of different things where I think we’ve
been able to accomplish significant milestones, especially with the OCM,” said Diaz, pointing to 5 consecutive years of shared savings and other milestones.

The care management infrastructure has led to a host of savings initiatives,
“whether it’s 24/7 nurse on call, standardized protocol-driven symptom management, social and financial support for patients, [or] survivorship programs.”

The overview, Diaz said, shows how efforts to “increase value with transparency” and work with employers can help patients “improve their journey while reducing everyone’s costs.”

“All of this tied together helps us take better care of our patients,” Diaz concluded.