AJMC Roundtable: Evaluating the Management of Cancer Immunotherapy (CIT)

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Dr. Genschaw: The management of CIT [cancer immunotherapy] is one that we take pretty seriously and one that's driven by the physicians. Our approach is we have specialized teams. Those specialized teams meet to review pathways and how to properly utilize these important drugs now that would represent a big part of our expenditure, but important for the treatment of patients. How we're going to manage these moving forward is physician leadership. As we'll talk about is working with the payers to make sure that the patient gets the proper drug they need.

We had a lot of great discussions around the [AJMC] Roundtable about immunotherapies, and one of the things that really stood out for me and what we struggle here in West Michigan is the impact the payers have. I think that's gonna continue to be a problem. One thing is that our physicians get together and make a decision on what's best for the patient but unfortunately we have to deal with payers that sometimes put roadblocks up to what's appropriate for the patient. We tackle that through NCCN [National Comprehensive Cancer Network] guidelines and educating our payers, but what I find is that it's a common struggle within community practices to deal with payers on an ongoing basis and get the authorizations that we need. A lot of resources are dumped into working with the payers and getting the patients the drugs they need and getting them paid for. That seemed to be a pretty common theme.

NCCN guidelines are an important part of that. Our doctors follow NCCN guidelines. We try to take the “12-lane highway,” if you will, down to 6 and try to standardize where we feel it's appropriate. We know every patient is unique. Tools that we use — our electronic health record is helping us implement pathways, so it allows us to better track and use data of some of the outcomes and what doctors are using. The tools we're gonna continue to use NCCN guidelines, utilize our electronic health record to track utilization and help support following pathways. That's some of the tools. Some of the tools that we use help us in our value-based contracts as a participant in OCM [Oncology Care Model], a very successful practice in OCM where we used the standardization in using those tools. That plays an important part of using immunotherapies. Like I said, they're very expensive and we wanna use them at the right time on the right patients and guidelines help with that. NCCN helps with that or EMR [electronic medical records] helps that and the specialized groups too.

Moving forward — the financial impact, there is a lot of uncertainty regarding OCM and we probably all have our different opinions of where it's going. I think we're gonna have a pause in OCM and hopefully, work with our colleagues in Washington D.C. to come up with a different model that we felt OCM was very successful for us to change the mindset. In regard to immunotherapy there is a financial impact. I think we all need to understand these great therapies are expensive. We want to use them at the right time on the right patients. If we can all agree upon standardizations and pathways, it will be successful in properly utilizing these. One of the things I want to advocate is we work with our commercial payers. If we all agree upon standards and pathways, why do we need this lengthy and costly authorization process? If we all agree upon upfront, so we're being proactive, why are we putting all the barriers and efforts into authorizations when we've already agreed upfront how we're gonna properly use these drugs? We should always have a partnership with our payers, but we need to start removing these barriers to patient care.

I think we need to engage our payers as early as possible when these therapies have new indications, when new therapies come online around immunotherapy. We need to be interacting with their payers and actually taking a step further besides the payers if there's an opportunity to meet with employers. Those are the ones ultimately paying the bill as the employer and they need to understand these are costly therapies that are wonderful for their employees and we're doing everything we can to properly utilize these drugs. We don't set the price for these drugs but we're ensuring they're being used properly and we're following guidelines so we need a partner. My big takeaway in looking into the future is I guess they're working with the payers, finding partnerships and ensuring the patients, employers, and payers that we are following guidelines and we're properly utilizing these drugs.

Transcript edited for clarity.