Interviews

OCM provides focus on individual patient cases. Learn how OCM affects the interaction between healthcare professional and patient.

Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare, discusses the partnership that is established with the implementation of episode-based payments, because now the physicians and other stakeholders have the same goal.

While the healthcare industry moves more toward value-based payment models, oncology practices are at a disadvantage because few payers truly understand the nuances of cancer care to design good oncology payment models, explained Aaron Lyss, director of value-based care for Tennessee Oncology.

Success in primary care should be based on how efficient and effective the physician is caring for the patient, and how satisfied the patient is with his or her care, rather than how many patients a physician is seeing in a day, said Charlie Fazio, MD, senior vice president and medical director of HealthPartners.

With 35% of Americans having prediabetes, prevention is clearly a priority, but many strategies have not bee translated into clinical practice because there is no system for reimbursement yet, explained Paul Chew, MD, chief medical officer of Omada Health

Flatiron Health focuses on helping community oncologists because they still care for the majority of patients with cancer and make it possible for patients to get care without traveling long distances, explained Nat Turner, co-founder and CEO of Flatiron Health.

While the ongoing healthcare debate in Congress creating a lot of uncertainty among the healthcare industry, there are areas of certainty and optimism, said Dan Todd, JD, principal at Todd Strategy.

Despite the politics involved in healthcare, it seems unlikely that the industry to going to stop its migration toward more accountability for quality, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

As the healthcare industry moves more toward value-based payments, practices have a real need for data that is usable and can help them succeed in new payment models, Kim Woofter, executive vice president of strategic alliances and practice innovation at the Advanced Centers for Cancer Care, explained at OncoCloud '17, held by Flatiron Health September 16-17 in Las Vegas, Nevada.

Although direct spending on primary care is low compared with other areas in healthcare, spending on innovations in primary care is important, explained Charlie Fazio, MD, senior vice president and medical director of HealthPartners.

There are a number of challenges with implementing value-based payment models in oncology, but it's an exciting time and offshoots of the Oncology Care Model (OCM) can "revolutionize" cancer care delivery, said Michael Kolodziej, MD, national medical director of managed care strategy at Flatiron Health.

Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team, discusses how Medicare will address and possibly change its biosimilar policies as the FDA offers more guidance and as biosimilars become more prevalent in the market.

Having employers and accountable care organizations agree on expectations is necessary for better alignment of care offered, explained Brian Marcotte, president and CEO of the National Business Group on Health.

Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare, discusses off-label communications and how coverage determinations are changing along with the production of new immunotherapy agents.

High drug prices have created barriers to accessing medications, and Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health, suggests that the pricing algorithms need to change in order to improve this dilemma.

Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, explains how previous experience with alternative payment models helped a smooth transition into the Oncology Care Model (OCM).

States are addressing biosimilars in different ways and putting different regulations in place as biosimilars become more prevalent in the market, explained Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team.

There are 3 different areas of healthcare that all face different challenges in implementing population health and adopting new reimbursement models, explained Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Charlie Fazio, MD, senior vice president and medical director of HealthPartners discusses how to balance different payment models in order to understand their impacts on cost and patient outcomes when they are implemented.

AJMC caught up with several healthcare professionals at a New Jersey airport before they took off for Houston to help out in the aftermath of Hurricane Harvey.

If physicians had better data systems with better information within their practices, then they could provide more accurate results and improve the care for the patient, explained Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare.

The healthcare systems in Germany and the United Kingdom are examples of systems that are able to manage costs while improving access to medications; however, it is unlikely that the US will follow these models, explained Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health.

Employers understand what accountable care organizations are, but they need a better understanding of how they deliver value better than the market, explained Brian Marcotte, president and CEO of the National Business Group on Health

The US biosimilar market is developing, but its sustainability in the market is still unknown, according to Amanda Forys, MSPH, director of Xcenda’s Reimbursement Policy Insights consulting team.

UnitedHealth is currently involved in 2 types of value-based contracts with its provider partners, but it has seen more success with one compared with the other, explained Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare.

Peer-to-peer support programs motivate and encourage patients to make better healthcare choices but they require certain regulations and processes to function properly and effectively, says Andrea Baer, director of Patient Advocacy for Mended Hearts.

Public interest and what is in the best public interest can vary from court to court, and in the case of Amgen v Sanofi, it has yet to be determined if public interest will be considered, explained Ha Kung Wong, JD, partner at Fitzpatrick, Cella, Harper and Scinto.

The public health community, the provider community, and the general public need to help the pharmaceutical industry increase access to services and put downward pressure on costs, said Gerard Anderson, PhD, of Johns Hopkins Bloomberg School of Public Health.

Biosimilars products can affect the development of new reimbursement models and formulary placement strategies as more people become educated on biosimilars, explained Amanda Forys, MBA, director of Xcenda’s Reimbursement Policy Insights consulting team.

Building strong teams and creating a support system is important in implementing innovation in primary care, according to Alicia Berkemeyer, vice president of Enterprise Primary Care and Pharmacy Programs at Arkansas Blue Cross and Blue Shield.