The Price of Innovation When Improving Cancer Care Delivery

Improving patient outcomes, ensuring the cost of care remains in check, and not losing sight of the patient at the center of it all—healthcare can be tough. And this transition to value-based care requires innovative approaches to care delivery by all involved.

At the Association of Community Cancer Center’s 44th Annual Meeting & Cancer Center Business Summit, March 14-16, 2018, in Washington, DC, payer and physician representatives shared the stage with the president of a cancer foundation that is striving to break the barriers that prevent easy healthcare information exchange and access to cancer care. Participants included Roy A. Beveridge, MD, chief medical officer, Humana; Barbara McAneny, MD, FASCO, MACP, president, American Medical Association (AMA); Anand Shah, MD, MPH, chief medical officer, Center for Medicare and Medicaid Innovation (CMMI); and Greg Simon, JD, president, Biden Cancer Initiative. Harlan Levine, MD, City of Hope moderated the discussion.

Levine asked the panelists to provide context to the audience, asking them, “Why are you on this panel?” on innovation in cancer care delivery.

McAneny said that AMA is working to create tools that would make things easier for physicians. “We are designing the workflow that physicians use to be the center piece. There’s a tremendous influx of data and we do not want to drown in it, but use it smartly,” McAneny said. She added that interoperability is a buzz word, but doctors want all the information on wherever their patients have been treated. “AMA has taken this up by setting a consortium to sort and transfer patient information within sites of care,” she added.

McAneny then moved on to discuss the influence of social determinants of health (SDH) on patient outcomes and cost of healthcare. There has been growing realization, among health policy researchers who have been studying this for a while and among providers, that environmental factors and where we stay have a big influence on our treatment outcomes.

“SDH is also high on our agenda. We are not measured based on a patient’s zip code,” McAneny said, but efforts are underway to develop measures, and a code, that account for SDH. “We need to level the playing field, to accounting for disparities,” McAneny added.

Payers recognize the influence of interoperability on efficiency, according to Beveridge. “The inability to exchange data is profound…we have been working with CMS to figure out ways to break data exclusivity and improve sharing [among stakeholders],” he said. He agreed with McAneny on the influence of SDH on not just outcomes, but also the cost of care. “In patients with malignancies, cost of care ranges about 2-6 times higher [among patients who face social challenges],” Beveridge said.

For Simon and his team at the Biden Cancer Initiative, interoperability is incredibly important. “We need to develop data-sharing models, launch virtual clinical trials, and we should conduct trials where people are,” Simon emphasized. He also underscored the importance of cross-pollinating innovative care models between health systems and community-based practices. “How can we let big cities know what’s happening in the community? We need to work toward creating standardized systems, and connectivity is key,” Simon said.

“CMMI is constantly trying to test new models and services, which can potentially reduce burden, because they require scale and the burden could potentially lead to consolidation. My role [at CMMI] is to make the system more accessible, affordable, and multi-stakeholder—driven for care providers,” Shah said.

Levine then asked the panelists what they would like to change about the system and the steps they would take to implement changes.

“Transparency of the system,” McAneny said. “We rank 19th among industrialized nations with respect to the transparency within our healthcare system,” she said, adding that the stream of middlemen between the patient and the provider add significant costs that are not very visible.

She reiterated the importance of SDH on improving the overall health of our care system.

Simon took a very stance. “Abolish tenure,” he said. In his belief, faculty at academic institutions apply for grants, which are then used to conduct research. However, 40% of the time, companies that spinoff from these laboratories are not able to reproduce some of the results that were originally published, according to Simon. This statement underscored the vicious cycle that exists between grant-writing, faculty tenure, and the business of science and health.

For Shah, it’s the mantra of patient-first. “We have a long-way to go to provide patients with the tools for enhancing transparency and making them aware of their choices and to make them engaged,” he said.

From the payer perspective, investment for innovation is important. “I like Medical Advantage,” Beveridge said, “because it’s a stable payment platform, our patients stay with us for about 8 years, and its risk-adjusted. It also helps you figure what is important for patients: food insecurity, transportation etc.”

How about the cost of innovation? “What happens if innovation makes our health system costlier, despite the promise of improved outcomes?” Levine asked.

Beveridge clarified that payers are willing to pay if they see a significant improvement in care delivery or treatment outcomes. “Remember: payers represent employer groups or the government when they make decisions on what they are willing to pay [for a drug or treatment],” he said. He raised concerns with the inefficiencies of the existing system, including treatments that are not of high-quality. “There’s a lot of waste, and unless we have the cost-benefit information, we can’t do much, Beveridge added.

Simon presented a different viewpoint on how better health has a positive impact on the economy because the patient [read workforce] is now doing better. “In healthcare, we do not think of health as an asset… why is it treated as a cost?” he asked.

Insurance companies do not know their liabilities or their patients a year in advance. If insurance companies cannot protect their risk in the healthcare world, that’s tough.

“Our focus has to be what we can do for the individual patient. Our current track is healthcare, which does not translate into health,” said McAneny. “We need to look responsibly at how do we deliver new treatments to patients without breaking the bank. Can we afford to spend 1.5- to 3-times for the same service and outcomes in a hospital vs physician setting.”

Levine finally asked the panelists’ perspectives on innovation: How do they impact practicing physicians? What will the doctors experience over the next few years?

With CMMI, physicians feel they have an opportunity, McAneny said. “One thing that the Oncology Care Model )OCM) has created is that CMS is not an adversary, rather a partner. AMA is working on helping physicians across the country to look at APMs, to help physicians from different specialties and communities to submit ideas,” she said, adding that payers have realized that 1-size fits all will not serve as a good model.

“We need to come up with a way to improve the quality of the affordable care that we provide, but we cannot afford to destroy the infrastructure that provides this care, in the process,” McAneny said, addressing the administrative and financial burden that some of the reporting requirements demand. The panelists agreed that physicians cannot be put at risk for things they cannot control.

Beveridge emphasized the need for alignment. “We need to understand data flow to help empower physicians. With the movement from volume to value, there’s a change in relations among stakeholders,” which he said is evident in primary care, where there are aligned interests, but has yet to be fully embraced in oncology. “Improving health, improving their functionality, and aligning it with payers is key,” Beveridge said.