COA's Bo Gamble: Help Your Patient, Not Your Profit Center

Bo Gamble, the longtime director of strategic practice initiatives at the Community Oncology Alliance, was honored October 24, 2022, at the COA Payer Exchange Summit in Tyson’s Corner, Virginia, for his service to the organization and his work to bring transformation to cancer care. Gamble, who joined COA full-time in May 2011, will be transitioning to part-time status January 1, 2023, when he will mentor 2 new staff members taking on COA initiatives. Gamble will also work with the American Society of Clinical Oncology (ASCO) to implement the Oncology Medical Home certification program, a joint effort of ASCO and COA. Gamble, a board member for Evidence-Based Oncology™, spoke with The American Journal of Managed Care^® about his work with COA. In this portion of the interview, Gamble talks about obstacles in the way of patient-centered care and how to overcome them.

Transcript

What accomplishment during your time with COA are you most proud of?

As far as specific accomplishments, I would probably name 3 accomplished. One is the growth of our network for peer-to-peer support, the Administrators' Network. I started that process back when I was at a practice when COA was young—we were like just a year or 2 getting started—I was at a practice and Ted [Okon, MBA, executive director at COA] and the team says we really want to engage the administrators. We started a group maybe of 5 people back almost 20 years ago, and now we're close to 1000, so growing that network. And we don't have the magic sauce, we're just being the conduit that says talk to each other, and we'll facilitate those discussions so people doing great things can share with people that are struggling, and vice versa, to help each other to just grow. It's been phenomenal seeing the growth. We've had calls once a month, usually sharing best practices between people. That's been one [accomplishment].

The other one I'd say is just being involved in the reform space. As you know, in this world of health care, the more we know, sometimes the more we're like, "this doesn't make any sense, we need to fix it." There's so much misalignment for patient care as it should be, and getting rid of obstacles so that care is for them. You see insurance premiums going up, you see coverage getting lower, you see obstacles all over the place trying to help the patients. In cancer care particularly, we're seeing physicians leaving the community practice and going to another sight of care, which is usually twice as expensive, and now we're arguing if the quality is good. That shouldn't happen, we should fix that. So we're trying to create some visibility and some education that says preserve and protect and promote high quality, value-based care, and we would argue, we want to prove it's on the community center. So making progress in that area, we're not there yet...the more we know, the more we know there is to do. So we're pondering trying to find those issues and make them transparent, visible, and try to address them.

The third item is one that's near and dear to my heart I shared last week that our payer Summit, and that is a collaboration and partnership with ASCO [American Society of Clinical Oncology] for the new and improved Oncology Medical Home, APC4 Program, which is ASCO Patient-Centered Cancer Care Program.

We've challenged people and said, "tell us what needs to be changed." We cannot come up with a single payment model that works for everybody. There's too much other ideas, or even pride and egos, "mine's better than yours," it would be a wasted breath if we tried to say do this for all. However, we are of the belief that, can we not come to an agreement on the specifics of what makes high quality cancer care, specifically, for everybody—for the patient to look for, for insurance companies to look for, for employers, for providers, all moving in that direction—and then you can build anything you want to on top of it.

That's what's so magical about this program. To me, it's the most meaningful, important thing that I've seen in cancer care as long as I've been in cancer care now for about 25 years. It just makes good sense and it's good for everybody. The standards are out there. You think you're doing it? Hey, go for it, do it. When you're ready for us to come look behind you and see if you're there, we'd be glad, but go ahead, move in these directions. A lot people said early on, "Bo, these are easy," I'm like, "not really." When you start trying to prove how well you're doing things and have to measure that you've done it really, really well, that's a different conversation. And getting people to that point of, "if you're as good as you say you are, prove it to me. I'm a patient coming in on a street, I'm thinking I want the best cancer care. How do I know yours is best? Prove it to them." That's what makes this so good. I'm looking forward to the end of the pilot, which will be June of 2023, and hopefully start a national program where we can get lots and lots of interest. We've got a standardized blueprint that we'll continue to be improved for all to follow for high quality cancer care.

What has surprised you over the years?

The one that's really aggravated me [is that] COA has reputation of being anti 340B. We are not anti 340B, we're pro patient. Therefore, if you're getting assistance to help patients, help patients. Don't help your profit center, your bottom line, that's not what it's about. I grew up in health care—good gracious—before I got involved in cancer care. There's this program called the Hill-Burton Program. I don't know if you've ever heard of it, I think it started like 1945. It was a program that says we want hospitals to be able to do the capital improvements to make sure that we're providing care. And we'll help you, we'll give you some low interest, whatever, give you some ability to make that happen. In exchange, you have to help patients. You had to have patients apply for and prove their income level and, based on their income level, they got either free care or greatly discounted care. Just wrote it off. It was for the patient.

Why can't we get back to that? Because that was when health care prices were low, patients were getting access, they were getting care, there was no fear of going to the hospital because I'm going to bankrupt my family. It's about the patient. Why can't we get back to that? That's just so simple, it's not that hard. We need to have assistance programs specifically for the patient. To me, if there was 1 thing, 1 thing that I think we could accomplish that would send a signal like, "nope, we're going to start doing things right," fix that program. It's just gotten crazy, it's just gotten out of control, and for all the wrong reasons. That's the one thing that surprised me.

There's other ways certain guidelines are written like Medicare Advantage and how they're allowed to have these obstacles in the way. Fix that too. We need to get rid of all obstacles that are getting in the way of the patient getting their care. My argument is—and I think it's universal to COA—we believe that community cancer care is the best quality, best value, best care, level playing field, may the best man win. And if we're not, we'll work hard to prove it, but level it so that we can play fairly all the way around so there's incentive to do the right thing and not an incentive to do [something] that's just not healthy.

Transcript edited lightly for clarity.