Interviews

Wayne Burton, MD, former global corporate medical director for American Express, discusses what he views as the key takeaways from a migraine peer exchange he recently participated in.

Therapies for rare diseases, such as gene therapy, pose very unique challenges to value assessments in a variety of different ways, explained Paul Melmeyer, director of Federal Policy, National Organization for Rare Disorders.

The long time between when a performance period ends and when the report comes out in the Oncology Care Model (OCM) can make it difficult to measure the impact specific changes are making, said David Ortiz, OCM program director at Montefiore Einstein Center for Cancer Care.

Changes with health plans can be disruptive to patients with diabetes who face changes in supplies and medications that make it difficult to manage their disease, said Jaime A. Davidson, MD, FACP, MACE, professor of medicine, Touchstone Diabetes Center, The University of Texas Southwestern Medical Center.

Things like smoking, poor diet, and lack of exercise can increase a person’s risk of developing cancer, but there are some things that are actually more clinically acute outside of family history that every patient needs to look out for, explained Feyi Olopade Ayodele, MBA, chief executive officer at CancerIQ.

In the last 2 decades, the cost of healthcare has risen, but the expectations of self-management for people with diabetes has stayed the same, which has made it more challenging to live with the disease, said Kellie Rodriguez, RN, MSN, MBA, CDE, director, Global Diabetes Program, Parkland Health & Hospital System.

From the health system perspective, there needs to be improvement in treating HIV as a comprehensive disease that now goes into aging, explained Stella A. Safo, MD, assistant professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Alliances are going to help community oncology participate in things that, as individual practices, they don‘t have the opportunity to do, said Barry Russo, chief executive officer of The Center for Cancer and Blood Disorders.

Shoshana Lipson, a patient advocate and founder of the “CGRP & Migraine Community ” on Facebook explains the patient perspective of CGRP inhibitors.

With CancerIQ, we’re really going to be helping push population health into the oncology arena where we can hopefully predict and preempt this very costly and devastating disease well in advance, says Feyi Olopade Ayodele, MBA, chief executive officer at CancerIQ.

The Oncology Care Model (OCM) has set off a ripple of change in cancer care that extends beyond the patients who are in the model, said David Ortiz, OCM program director at Montefiore Einstein Center for Cancer Care.

Humana has expanded its focus to the social determinants of health because issues like food insecurity and lack of transportation impact outcomes even if patients are getting the best medical care, said Bryan Loy, MD, physician lead, oncology, laboratory, and personalized medicine, Humana.

Pharmacists, social support services, an information technology team, and financial counselors all come together to encompass the care for the patient, says Beth Wittmer, RN, OCN, manager of care management at Florida Cancer Specialists and Research Institute.

The advantage of having mandatory models is it enables you to get participation broadly across the community and it allows you to design the bundle in a way that’s not so intent on encouraging participation. If you have voluntary participation you are somewhat limited as to how you could design the bundle, because if you design it too aggressively no one will participate, explained Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy; director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School; and co-editor-in-chief of The American Journal of Managed Care®.

Triage pathways can transform practices and save practices and CMS money by keeping people out of the emergency department and hospital, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

Research has shown that females are more susceptible to developing multiple sclerosis (MS) than males, but males have worse disease progression, and studying those sex differences can help lead to new treatments, said Rhonda Voskuhl, MD, Jack H. Skirball chair of MS research, director of the MS program, and professor of neurology at the University of California, Los Angeles (UCLA).

With a biomarker attached, the odds of a drug being approved goes up from about 10% to greater than 25%, explained Howard A. "Skip" Burris, III, MD, FACP, FASCO, president, clinical operations, and chief medical officer of Sarah Cannon Research Institute.

Wayne Burton, MD, former global corporate medical director, American Express, explains the benefits of migraine education programs in the workplace.

Some of the health policies coming out of Washington, DC, are clever, but there might be too much coming out for practices to keep up with, said Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

Patients who adhere to a CancerIQ cancer prevention plan, or cancer survivorship plan, are more likely to catch a cancer before it grows beyond 1 centimeter, says Feyi Olopade Ayodele, MBA, chief executive officer at CancerIQ.

An artificial intelligence system can digest what would take a person 29 hours to read in about 30 seconds, so everything is right in front of providers at the point of care, says Barry Russo, chief executive officer of The Center for Cancer and Blood Disorders.

Stephen Grubbs, MD, vice president of clinical affairs at the American Society of Clinical Oncology, explains what stakeholders can expect from the new updates to the Patient-Centered Oncology Payment (PCOP) model, as well as some key differences between PCOP and the Oncology Care Model.

We need to find someone who’s doing very strong, rigorous research and then we need to find someone who’s doing work on really important topics, says Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy; director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School; and co-editor-in-chief of The American Journal of Managed Care®.

Blase Polite, MD, associate professor of medicine and the executive director for accountable care at the University of Chicago, discusses why he chose to focus on the state of the Oncology Care Model at the April 25 meeting of the Institute for Value-Based Medicine.

As we move away from a system of external development grants that help us maintain our HIV models to a system where our returns on investment support the work that we do, there’s a concern that there will be some slimming down of services that get patients in to our practice, explained Stella A. Safo, MD, assistant professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Payers, providers, and other stakeholders have to come together to figure out how to make a better patient member experience for those who are fighting cancer, said Bryan Loy, MD, physician lead, oncology, laboratory, and personalized medicine, Humana.

After the first 2 performance periods of the Oncology Care Model, it became clear hospice care was an area where Northwest Medical Specialties could improve, and care coordinators could help, said Jessa Dunivan, patient services manager, Northwest Medical Specialties.

Having a care management team in place builds trust with patients so they are caught before something really serious happens that sends them to the emergency department, said Beth Wittmer, RN, OCN, manager of care management at Florida Cancer Specialists and Research Institute.

The standard treatment isn’t always right for everyone, and part of a social worker’s job as a member of the care team is to understand the patient’s goals and what treatment is the right fit for them, said Abra Kelson, MSW, LSWA-IC, medical social work supervisor, Northwest Medical Specialties.

Awards need to also recognize researchers whose work has an impact on policy and can be translated for policy makers and even the broader public to understand, said Dana Goldman, PhD, the Leonard D. Schaeffer Chair and director of the USC Leonard D. Schaeffer Center for Health Policy and Economics and Professor of Public Policy, Pharmacy, and Economics at the USC Sol Price School of Public Policy and USC School of Pharmacy.