Interviews

Patients and physicians both indicated on a survey that they would like to spend more time on visits, but often this is not feasible for physicians who are burdened with other time-consuming requirements like charting and billing, according to Allan Gibofsky, MD, professor of medicine and public health at Weill Cornell Medical College and an attending rheumatologist at Hospital for Special Surgery.

Immuno-oncology is often portrayed as having less severe side effects than chemotherapy, but patients need to be aware that it does carry some risks, said Debra L. Madden, cancer research advocate and patient representative. Patients should not hesitate to report any adverse effects to their doctor.

The Camden Coalition has hospital-based, community-based, and social work teams that work together to build relationships with patients, said Renee Murray, associate clinical director of Care Management Initiatives at Camden Coalition. Although each team member has a specialized role, they all pick up skills and learn from one another.

The transition to value-based care has been helpful in getting providers to examine their own performance and find ways to improve quality, said Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

CMS has been making efforts to reduce administrative burdens for physicians as the healthcare industry moves to value-based care through the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Healthy Policy.

Research into the financial performance of Medicare accountable care organizations (ACOs) has found that organizations benefit from having prior experience with risk-bearing contracts, but that organizations that had reduced growth in healthcare spending before joining an ACO would find it difficult to improve further and share in savings, according to Marietou Ouayogode, PhD.

In Hennepin County, Minnesota, the local government has gotten into the business of healthcare and linked a variety of services into an accountable care organization (ACO) model that not only addresses beneficiaries' health needs, but also their social determinants of health, explained Ross Owen, health strategy director of Hennepin County..

The FDA has been willing to explore the utilization of surrogate endpoints like tumor response in clinical trials, but it is unclear whether these endpoints correlate with overall survival, said David Fabrizio of Foundation Medicine, Inc. However, he emphasized that overall survival does not necessarily benefit the patient if the additional days gained are not quality days.

Cancer Outcomes Tracking and Analytics (COTA) focuses on stratifying cancer patients by their many subtypes to understand the different treatments, outcomes, and costs for each, according to Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

In order to make palliative care accessible in every community, the Center to Advance Palliative Care works to educate clinicians, raise awareness among patients, and maintain adequate funding, according to Allison Silvers, vice president of payment and policy at the Center to Advance Palliative Care.

By 2020, more plans will incorporate value-based insurance design (VBID) principles as a way to lower cost sharing for high-value services and potentially increase cost sharing for low-value services, according to Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School.

The idea of risk sharing within value-based care is a wonderful concept, but it has not yet changed behavior and outcomes to the extent one would hope, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center. A potential reason is the variation in metrics and incentives used within different systems.

In a convenient care setting, collaboration is key to providing comprehensive care and thorough information to patients whether they have a primary care physician or not, said Kristene Diggins, FAANP, CNE, NEA‐BC, DNP, MBA, manager of professional practice at MinuteClinic.

The criteria to enroll cancer patients in a clinical trial of CAR-T cells vary according to their disease, past therapy, and how far along they are in different treatments, said David L. Porter, MD, of the University of Pennsylvania Health System.

Patient-centered medical homes are valuable because they allow insurers to look at the cost of all of the patient’s treatments, services, and physicians throughout the continuum of care, explained Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ.

Patients need help shaking off the negative stigma associated with obesity and improving their self-worth before they can start to work with clinicians on treating the disease process, said Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital.

Technological advances in cancer care have changed the very process of treatment, as now oncologists can gain more insight into the most effective therapy for each individual patient, according to Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology.

Aetna has developed a number of initiatives and partnerships to help address the social determinants of health for needy patients outside of the clinical setting, according to Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

The most transformative software companies are those that have seized the opportunity to incorporate clinician and patient voices into the design of their health IT tools, according to Carrie Stricker, PhD, RN, AOCN, chief clinical officer and co-founder of Carevive.

Patients are becoming more engaged in their own healthcare, meaning they have more input in the quality measurement process and can even help develop quality measures for the future, said Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council.

Researchers implementing the TAPUR trial have encountered some difficulties, particularly in filling the study cohorts, said Pam Mangat, MS, associate director TAPUR study at the American Society of Clinical Oncology (ASCO). However, the ASCO team is dedicated to forging ahead and addressing those challenges.

The traditional care team model places doctors in charge of the team, but this structure may not be the most effective for complex patients with social challenges and other issues, said Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers.

The Information Exchange and Data Transformation initiative at the FDA uses oncology data from not only clinical trials but also electronic health records and biosensors. This patient-centered approach brings research to the real world, as many oncology patients are excluded from clinical trials, said Sean Khozin, MD, MPH, senior medical officer at the FDA.

Underinsurance, which occurs when people have insurance but aren't covered for services they need, is a serious problem in the US, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan. He proposed some strategies to alleviate this phenomenon, like smarter deductibles and revised Internal Revenue Service (IRS) rules.

The state of current software systems, primarily electronic medical records, is a significant barrier to implementing successful health IT tools, said Jonathan Hirsch, founder and president of Syapse. He also explained some of the solutions developed by Syapse to address these challenges, like improving the software’s integration capabilities and making it more usable for providers.

As the shift from volume-based care to value-based care continues, providers will require a whole new mindset and skillset to be successful, according to Katherine Schneider, MD, president of the Delaware Valley ACO.

Data from electronic health records aren’t always helpful for oncologists, which is why the founders of Cancer Outcomes Tracking and Analysis (COTA) developed a platform that stratifies patients by relevant characteristics, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Physicians may have a hard time relinquishing their own piece of the healthcare puzzle, whether due to financial incentives or inadequate care coordination, said Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center.

Oncologists need to ask patients the right questions and truly listen to the answers, but they must then balance the individuals’ goals with the practice’s efforts to provide consistently efficient cancer care to all patients, according to Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network.

Bundled payment models could provide surgeons with a full spectrum of data that can help them decide which hospital is the right choice for their patients, said Andrei Gonzales, MD, McKesson's director of value-based reimbursement initiatives. He also said that this data can drive improvement for hospitals that may be falling behind.