Emerging Oncology Trends: A Chat With COA's Ted Okon

At the end of February, Ted Okon, MBA, executive director of the Community Oncology Alliance (COA), answered questions on Twitter about the latest trends in cancer care and discussed COA’s concerns with the president’s moonshot initiative and the 340B drug pricing program.

If you missed the chat, here’s a look at the best of the best. We started the discussion with the cancer moonshot:

Q1. Earlier this year, President Obama announced the cancer moonshot. What are the challenges you foresee with this initiative? #AJMCchat

— AJMC (@AJMC_Journal) February 29, 2016

A1. At moment, @POTUS & @VP #CancerMoonshot is grounded. #POTUSbudget fails us. Read our full statement https://t.co/ATCmTmxCBT #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

The president’s budget proposed cuts to how Medicare payments for cancer drugs. COA President Bruce Gould, MD, said in a statement: “These cuts to cancer care increase costs to patients and handicap community cancer practices that are the primary participants in vital clinical trials. The President calls for a moonshot on cancer but his budget, with misguided cuts and insufficient research funding, scuttles the rocket before it even gets to the launch pad.”

In addition, Okon tweeted that the budget would destroy community oncology.

A1. HUGE issue: #CancerMoonshot doesn't have community oncology @ table. We do majority of clinical research needed 4 success! #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

Next the conversation moved on to the controversial 340B program.

Q2. @oncologyCOA has been very outspoken about the 340B drug pricing problem. What are your biggest issues how 340B is used? #AJMCchat

— AJMC (@AJMC_Journal) February 29, 2016

A2. #340B being used by #hospitals to consolidate #cancer care system, make $$$ profit off of #patients #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

One of the resources Okon pointed to was an article written by Rena M. Conti, PhD, in New England Journal of Medicine, which claimed the program was too vast and suggested better targeting of the 340B program would improve affordability for patients and payers.

Dr Conti also co-wrote an article for the December 2015 issue of Evidence-Based Oncology suggesting 3 possible steps to enhance the function of 340B.

A2. Even @USGAO is concerned about #340B program & #hospital profits https://t.co/MQ0euLPzgO #AJMCchat pic.twitter.com/dh9YQdUNlQ

— Community Oncology (@oncologyCOA) February 29, 2016

A3. We truly believe in #340B. But bad actors abuse threatens those who truly need it. Need reform to #protect340B & #sustain340B #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

A3. #340B solutions incl. update eligible #patient definitions & charity care reqs, #transparency of data & patient benefits #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

@oncologyCOA Do you think passing #340B discounts to payers and patients is feasible? see https://t.co/t7hscXIJJe #AJMCchat

— AJMC-Oncology (@EBOncology) February 29, 2016

Good Q @EBOncology (to Q3). Currently not politically feasible. 1st step more transparency, accountability, & patient definition #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

With all of healthcare moving to value-based care, oncology will follow. Okon and COA acknowledge that alternative payment models are not a fad and that they will change cancer care.

Q4. Healthcare is moving toward value-based care and bundled payments are a big part of it. Do bundled payments work in #oncology? #AJMCchat

— AJMC (@AJMC_Journal) February 29, 2016

A4. Hard to tell if #valuebasedpayment or bundled payments work since @CMSinnovates won't start OCM Model or let HR1934 go fwd #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

A4. A cautious note: @UnitedHealthCare pilot INCREASED drug costs w #oncology bundled payments https://t.co/nXcjFKBf1C #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

Later, Okon mentioned that the Oncology Medical Home initiative is one way to better align physician compensation to value and healthcare quality.

Q8. How is patient care enhanced through the Oncology Medical Home? #AJMCchat

— AJMC (@AJMC_Journal) February 29, 2016

A8. #Oncology Medical Home model puts #patients @ the center. Measures patient feedback, focuses on quality & value for them #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

The Oncology Medical Home recently added a new partner, Midwest Business Group on Health, which represents 4-6 million covered lives. COA also continues to fine tune the initiative:

A9. And #quality, value measures for #Oncology Medical Home continue to be refined, incl. new #prostatecancer #AJMCchat #OMH

— Community Oncology (@oncologyCOA) February 29, 2016

Finally, Okon discussed consolidation in healthcare, and how it specifically affects oncology. One factor that has consolidation happening at an “alarming rate” in cancer care is the 340B program.

A10. Consolidation reduces #patient choice, increases costs (hence importance of #siteneutrality https://t.co/n9oPczAgln) #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

A10. FACT: 75% of community #oncology clinics closing/merging went to #340B hospitals https://t.co/QHwRSqLemP #AJMCchat

— Community Oncology (@oncologyCOA) February 29, 2016

The next #AJMCchat will be with Robert A. Gabbay, MD, PhD, FACP, chief medical officer and senior vice president of Joslin Diabetes Center. He will discuss diabetes management, performance measures, and the upcoming Patient-Centered Diabetes Care meeting.