Dr Rajini Katipamula-Malisetti: Minnesota Oncology Takes Value Very Seriously

Rajini Katipamula-Malisetti, MD, of Minnesota Oncology discussed value-based cancer care, one of the main topics explored at The American Journal of Managed Care^®’s Institute for Value-Based Medicine^® (IVBM) event in Minneapolis, Minnesota, on September 12, 2023.

Katipamula-Malisetti is executive vice president at Minnesota Oncology, and her areas of special interest include gastrointestinal oncology, breast cancer, cancer genetics, and lung cancer. She also was the chair of the IVBM.

Transcript

One topic discussed at the IVBM was value-based cancer care. Can you briefly explain how Minnesota Oncology approaches value-based care?

We have a very, very strong quality program at Minnesota Oncology. I am the quality medical director, and we have a team that's really dedicated, and we have quality metrics for our physicians.

We believe in doing the right thing for the patient, and that includes not just saying we are giving state-of-the-art treatment, but also the most effective and high value, and keep trying to keep that cost down. Because we are able to do that, and we thought we do a good job, we are actually a part of the EOM [Enhancing Oncology Model], which is the Medicare quality program, and I think we're the only practice within this region that has signed up for it because we do believe in that value for the patient. We also are in value-based contracts with several of our payers. Like I said, we take value very, very seriously at Minnesota Oncology.

Why do you think value-based cancer care is important for patients going through these treatments?

If you look at literature, I think the number 1 cause of bankruptcy is medical treatments. Cancer care is probably the most expensive of all these. As we are developing new therapies, and really changing the world of cancer treatments, financial toxicity is something that is getting more and more and more important. As physicians, as oncologists, I think we are the ones that need to address it, or at least start that conversation.

We at Minnesota Oncology really believe in doing that initial assessment. We have our financial counselors sit and discuss their plan with the patient. We follow pathways; we generally try to maintain a 90% to 95% NCCN [National Comprehensive Cancer Network] adherence with all our pathways. We try to help the patients with their oral drug copay and trying to see what we can do that’s best for them.

We also have a very strong palliative care program and really have a goal to integrate that palliative care early on to improve those outcomes and have some of these conversations about end of life care choices, how care should be at the end of the life, and trying to decrease those end of life care costs where we spend a lot of dollars where patient does not really benefit but still is in the hospital and not the best quality that we can provide for the patient. We believe in all those things and really try to work on those.

Did the IVBM help identify any areas of improvement for the oncology community, more specifically the melanoma community?

One of the things that did come across as a gap or as a need during the conference we did was, how do we really incorporate biomarkers or testing to determine which patient might need treatment? Which patient do we stop treatment? Can we recognize a patient that might be more prone to getting these immune mediated side effects?

Those are still things that we need to incorporate maybe in the clinical studies as we are designing or have just a better understanding. Those would really help us in really tailoring our treatments to the patient. That was one of the things that I think was very cool to see as we were talking through.

The second thing was also, as we heard, the talk on immune therapy side effects, how much of a gap it is out in the community where we have a need to educate not just our patients, but their care team, our nurses, and physicians in the ED [emergency department], physicians in the hospital, because these side effects, if not picked up, can be pretty difficult to treat. The treatment may be just steroids, but it is something that we need more education on, and I think that was another thing that came through, which is a definite need we need to meet.