Collaboration to Ensure Access to Cancer Care Despite Increasing Cost Constraints

Making lifesaving but costly cancer therapies available to patients requires collaboration across the healthcare system, agreed a panel of stakeholders at the Business of Oncology Summit hosted by the Florida Society of Clinical Oncology.

Logistically, collaborating has always been a good idea, but it’s now necessary to survive, due to the happenings in the healthcare ecosystem over the past decade, said moderator Ira Klein, MD, senior director of healthcare quality strategy, Janssen. Payment methodologies are becoming increasingly based on outcomes, health systems and infrastructure are aggregating with mergers and acquisitions, and there is increased vertical and horizontal integration. These changes will affect patients, payers, delivery systems, and more, he said.

“We have a lot of change, a little chaos, and some different business rules than we had 10 years ago,” Klein summarized. In light of these changes, he asked the panelists to explain how they collaborate with other stakeholders.

Michael Diaz, MD, who is a practicing oncologist at Florida Cancer Specialists, said that he is often asked by local accountable care organizations how they can rein in the costs of cancer treatment, and he answers by explaining the clinical advantages of certain drugs for certain patients. For instance, sometimes a more expensive drug therapy can actually lower total costs if it helps avoid complications and hospitalizations. He also discussed his efforts to introduce end-of-life care conversations earlier in the course of treatment.

Vicki Trallo, RN, a patient navigator at Moffit Cancer Center, agreed that patients need to be better informed of their options. In her role, she has had to become knowledgeable on the basics of insurance because patients often are unaware of their coverage, benefits, and options. She mentioned that the patient education sheets from CancerCare and the American Society of Clinical Oncology (ASCO) are important tools that provide information patients can digest.

In addition to offering these patient-focused services, including educational modules on managing cancer and financial toxicity, ASCO is working to change the system starting at the top by issuing policy statements on proposed legislative changes, explained Stephen Grubbs, MD, vice president of clinical affairs, ASCO. For instance, ASCO recently took a position against Medicaid waivers to require enrollees to work, and it was active in the debate about repealing and replacing the Affordable Care Act without taking political sides. For ASCO, collaboration extends beyond the federal healthcare system, Grubbs added, to encourage employers to invest in employee health.

Another area in which collaboration is necessary for sustainability is in pharmaceutical development, said Al Wallace, field reimbursement manager, Bayer. The drug maker looked for a model for bringing a newly acquired drug to market that could benefit all stakeholders, even with the “difficult political climate” for putting a price tag on innovation. The company arrived at the idea of a money-back guarantee that would reimburse stakeholders—potentially including the patient, provider, payer, and pharmacy benefit manager—if a patient does not respond within 90 days. Although the idea is still in its infancy, it has sparked new conversations among stakeholders.

“This type of model is going to be part of the equation, if not the solution, in the future as we look at access to expensive products,” Wallace predicted.

Technology can also enable greater collaboration, said Diaz. Having integrated medical records and organized data can increase efficiency within an oncology practice, but it can also help evaluate which external components of the healthcare system add value to the patient and society. In this exciting time of growth in oncology, “everybody has to make sure resources are being allocated efficiently.”

As an example of collaboration on a national level, Grubbs discussed ASCO’s CancerLinQ initiative, which aims to aggregate real-world data from practices’ electronic health records to examine outcomes but has run into challenges in extracting that data. The “holy grail” of technology collaborations would be to accumulate complete clinical information and costs in one place, he said.

Wallace noted that pharmaceutical companies that work with patient counselors and navigators are finding that having multiple sets of eyes on the patients allows them to assess which patients need the most assistance. He said that the industry could still do a better job of making patients and providers aware of their programs to help patients afford drugs.

In response to an audience question on how to manage the high costs of expensive drug combinations, Grubbs noted the importance of judging stakeholders by the factors they can control. For instance, clinicians and practices should be held accountable for utilizing treatments appropriately in accordance with tools like the ASCO pathways, not for the costs of drugs.

Diaz agreed, and he added that he hopes to see more value-based reimbursement for medications as part of the future of cancer care. With the introduction of such proposals in the Oncology Care Model 2.0, support from groups like ASCO, and many pharmaceutical companies starting to embrace the idea, it seems increasingly likely.

“We are ethically obliged to make the best use of resources,” Diaz said. According to the experiences of the panelists, each stakeholder can start to meet that obligation by searching for areas of collaboration with other parts of the healthcare system.