Oncologists Believe Achieving Cancer Moonshot Goals Should Start in the Community

Vice President Joe Biden’s Cancer Moonshot initiative placed significant emphasis on the role of cancer centers in improving the nature of oncology care delivery in the country, ultimately to improve patient outcomes. However, community oncologists believe that they are in a very good position to lead the way.

Joining this discussion at the 2017 Community Oncology Conference, April 27-28, were William Harwin, MD, president and managing partner, Florida Cancer Specialists; Edward Licitra, MD, PhD, chief financial officer and director of revenue cycle, Central Jersey Division, Regional Cancer Care Associates (RCCA); and R. Steven Paulson, MD, President, Texas Oncology. Debra Patt, MD, MPH, MBA, vice president, Texas Oncology, moderated the discussion.

When asked about the role played by each of the practices in fueling Cancer Moonshot, Harwin said that there are many different factors that can influence Cancer Moonshot, including developing a patient care system. “We have about 50 patient managers, many of whom work remotely. We also have an active phase 1 unit on site, and that’s one of our biggest initiatives.”

As a result of requirements of the Oncology Care Model (OCM), Harwin's organization also has a care management team. “They are available 24 hours and provide triage, which is very valuable for our patients,” he added. The care management team, Harwin added, adhere to protocols developed for triage management and psychosocial support.

Paulson noted, however, that the challenge with OCM is the upfront investment for additional staffing requirements, to ensure reporting requirements and change implementation can be met. Paulson also addressed the importance of extending clinic hours to avoid emergency room visits.

“OCM has given us the ability to focus and change culture,” Licitra emphasized. He explained that the changes that a practice infuses to meet OCM requirements are not restricted to Medicare patients, rather, they extend to other patient populations as well. “While it is a work in progress, we are trying to centralize our processes,” he said, adding that RCCA is working with Innovative Oncology Business Solutions, co-founded by Barbara McAneny, MD, to bring this about.

“How important is research for your practice and how you have you built in in your practice?” Patt asked the panelists.

Licitra noted the importance of data integration to improve patient outcomes. RCCA is assembling all the genomics and proteomics information on patients and then trying to identify ways to improve outcomes. “We are using tools to understand both clinical and financial outcomes,” he added.

“We need people to realize the value of community oncology and they come to us and give us the opportunity to care for them,” Licitra said.

Paulson explained that Texas Oncology has built relations with hospitals, clinics, and the pharmaceutical industry to help support their in-house research efforts. “We try to create a situation where the best molecules are accessible to our patients,” he said.

He is, however, concerned with the low rate of clinical trial enrollment, especially among newly diagnosed patients.

Challenges With Delivering Research in the Community Setting

Patt indicated that in addition to operational costs, there are challenges with individual clinicians contributing time. “What are the other challenges that you face and how can they be overcome to facilitate research in the community clinic?” she asked.

Harwin said that his practice uses a clinical trial navigator and they also employ Flatiron Health’s OncoAnalytics platform. “But we cannot replace physicians,” Harwin said, emphasizing the need to raise awareness through fellowship programs.

“Patient identification and physician engagement are key,” Licitra said, indicating that modifying physician compensation models can have a significant impact.

Paulson agreed with Licitra. “You can change reimbursement models to include financial incentives for participate in clinical trials,” he said. Community clinics should work toward the goal of providing patients access to a research platform.

Clinical trials are a big saving because you don’t have to pay for the drugs, which is a huge saving, Harwin said.

To ensure timeliness of acquiring information, “We have our own molecular testing facility,” Paulson said. It also helps the clinic to better aggregate the patient’s molecular data along with clinical information. “We have also created an outpatient interventional radiology facility, which costs half of what we would pay for if patient goes to a hospital,” he added.

Patt said that clinical decision support is critical too, because it allows quality improvement, allows quicker treatment by helping with prior authorization, and improve outcomes. She also indicated the importance of telehealth for practices with multiple sites.

“We can’t have every expert at every site of care and we need to identify ways to bridge geographical gaps,” she explained, adding that telehealth services needs to grow quickly “because we may not provide all services at every site across large practices.”

Licitra believes that curing cancer and curing the cancer care delivery systems are the targets of reimbursement models, and they are both significant challenges. However, Paulson said that even if doctors do not like these changes, it is imporant to climb on board since the OCM is fueling the opportunity to bring about changes.

Pratt noted the importance of community oncologists “telling their story.”

“We need to allocate more time to this,” she said.