Different Vantage Points, but Similar Goals of High-Value Care, Patient Satisfaction

A diverse panel of representatives from different practice models provided insights into what has worked for them and what has not in trying to improve cancer care. The discussion took place in Washington, DC, at the Association of Community Cancer Centers’ 45th Annual Meeting and Cancer Center Business Summit, held March 21-22.

The session kicked off with highlights from the recent Trending Now in Cancer Care survey. Deirdre Saulet, PhD, practice manager at The Advisory Board Company, highlighted that respondents to the survey, which included people at nonteaching community hospitals, academic medical centers, and freestanding cancer clinics, identified symptom management, such as reducing emergency department visits, and clinical standardization as 2 of the biggest opportunities for cost savings. Identifying these areas is critical as healthcare may still be in fee-for-service, but it is increasingly moving toward value-based or outcomes-based payments.

On the flip side, respondents saw the biggest return on investment for cancer programs was care coordination, such as navigation.

“It’s not just enough to attract patients to your program anymore, you really need to sort of shepherd them throughout the process, keep them loyal to your system,” Saulet said.

Each of the panelists went through what their practice, program, or company does well. Linda Bosserman, MD, medical oncologist at City of Hope, highlighted its diversity, such as community centers that are not under 340B, as well as a center that is under 340B, the ability to bring together community oncologists and oncologists in the academic center to compare outcomes, and the push to bring surgeries, research, and treatment closer to the patient at home through the use of telemedicine.

OptumCare Cancer Care, a division of OptumCare, which is a subsidiary of UnitedHealthcare, is developing a multispecialty entity with surgery, radiation oncology, and medical oncology that practices quality care, follows guidelines from the National Comprehensive Cancer Network, and has a focus on patient satisfaction, according to Russell Goddard, MD, director of medical oncology at OptumCare Cancer Care. The cancer center is instituting a collaborative approach early on with nutritionists, psychologists, and palliative care doctors.

As a community practice, the Center for Cancer and Blood Disorders really knows its patients and their experience and what they can implement in order to improve that experience, explained Barry Russo, chief executive officer. When the practice noticed it had an issue with palliative care, it pulled in a palliative care issue; when it realized socioeconomic issues where significant for patients, it engaged social workers and dieticians and more.

“I think we’re nimble enough that we can react fast, we can see what some of the issues are, we get a lot of really direct feedback from patients because of the nature of our relationship… and I think that generates, ultimately, for us, a better product,” he said.

Meanwhile, OneOncology, which is a new organization bringing together 3 leading oncology practices—Tennessee Oncology, New York Cancer & Blood Specialists, and West Cancer Center—is empowering physicians in the community and physician-led community oncology practices to succeed. Erich A. Mounce, MSHA, chief operation officer at OneOncology, explained that the organization helps community oncologists get access to capital, technology, and expertise so they can compete with other entities, including academic institutions and giant not-for-profit hospitals.

“For us the best care is delivered in the community setting, no matter what, and that’s what we aim to continue,” Mounce said.

Inova Schar Cancer Institute recognized in 2014 that it had few closely associated practices and it made a commitment to change based on the realization that the future of cancer care was ambulatory, said Donald L. "Skip" Trump, MD, FACP, chief executive officer and executive director at Inova Schar Cancer Institute. Since then, Inova has made progress, developing a model that attempts to be patient centric by listening to patients and putting into place modern technology that had previously been lacking.

The goal, said Roger Brito, DO, national director of oncology at Aetna, is to be able to use all of these different network and practice models to focus on improving patient care overall. No one model is necessarily better than the other—they should be used together.

Saulet added that communication and coordination taking place among each of the groups is crucial and that, as a patient, she wants to know that her providers are all talking together and delivering cost-effective, patient-centered care in the appropriate setting.

However, no company, practice, or organization is perfect, and moderator Michael Kolodziej, MD, FACP, vice president and chief innovation officer at ADVI, challenged the panelists to acknowledge what they do poorly and need to improve upon.

Trump highlighted how much trouble Inova had getting everyone on the same page; Mounce discussed better investment in the workforce; Russo explained coordination across specialties was difficult, especially with everyone under different reimbursement structures; Gollard pointed to the jigsaw puzzle of providing quality and cost control in a population health model and getting true provider engagement; Russo said technology support that notifies the practice when a patient enters the emergency department or the outpatient setting; and Bosserman described the challenge of getting molecular data to the bedside and into the fingers of experts in real time.

The panelists finished with a discussion of the Oncology Care Model (OCM). They all, with the exception of Brito, believed OCM would continue, perhaps with some evolutionary changes.

While OCM is not perfect, it has pushed oncologists to look at a lot of things in the care process that they weren’t doing before, Russo said. However, his practice has struggled with the model. Despite having a cost of care per case that is on a downward trajectory, the Center for Cancer and Blood Disorders has not been financially successful under the model.

Mounce agreed, saying that OCM has allowed oncology to focus on things they needed to focus on, like coordinating care, investing in taking care of patients throughout the entire journey, and understanding how to link palliative care earlier.

While Brito thinks OCM makes sense conceptually, he said that he doesn’t like the data dumps that go to providers, because they struggle to make sense out of the information they receive. In addition, the current model does not do a good job taking into account novel therapies.

“As we look at the data, as it starts to mature, what we’re seeing is we need to come up with a 2.0, 3.0 strategy, because the immunotherapy agents changed the game,” Brito said.