Dr Olalekan Ajayi Previews Key Topics to Be Presented at the ACCC National Oncology Conference

Olalekan Ajayi, PharmD, MBA, 2023-2024 ACCC president | Image Credit: Highlands Oncology Group

Attendees at this year's Association of Community Cancer Centers (ACCC) National Oncology Conference can expect to learn more about relevant topics in community oncology care, including navigating value-based payment models, biosimilar uptake, leveraging health technologies, addressing health disparities, and more, noted ACCC 2023-2024 President Olalekan Ajayi, PharmD, MBA, chief operating officer of Highlands Oncology Group, PA.

The American Journal of Managed Care^® (AJMC^®) sat down for a conversation with Ajayi in the days leading up to this week's conference.

This transcript has been lightly edited for clarity.

AJMC: Can you share your presidency's theme and your goals for ACCC?

Ajayi: The theme of my presidency is on rebuilding our workforce to deliver the care of tomorrow. We want to take from the lessons of COVID-19 and the impact its had on the workforce. We also want to be able to integrate many aspects of oncology to be able to meet up with the changing needs and demands of oncology. This National Oncology Conference focuses on so much of that.

The oncology workforce is facing several challenges, including an aging workforce, a growing number of cancer patients, burnout, and the increasing complexity of cancer care. That is why I have focused the theme of my presidency on building the oncology workforce to deliver the cancer care of the future.

The National Oncology Conference is packed with presentations and practical information on how to create a positive work environment, promote diversity in the oncology workforce, and develop future oncology leaders and the use of technology and other resources to improve the efficiency and effectiveness of cancer care.

I am very excited and look forward to the learnings and conversations that will take place during the conference, and more importantly, hear from practices on how they are solving workforce challenges.

AJMC: How is ACCC addressing concerns around value-based payment models in community practices at the upcoming National Oncology Conference?

Ajayi: Value-based care and value-based care models have definitely been an evolving topic in the oncology landscape. There's been a lot of work done, particularly when we're looking at the Enhanced Oncology Model (EOM), which is basically a follow-up to the Oncology Care Model. Currently, we've had quite a few practices sign up for the model. ACCC is being proactive by addressing this on a few panel discussions to talk about the viability of the model, the challenges, and educate practices on what to expect with the EOM.

One of the other areas that we've been very active about is in the Medicare Advantage (MA) field, where we're beginning to educate practices on the impact of MA plans as well. Both of these topics are addressed in the upcoming conference. And we're going to have practices coming in with really good tips on the infrastructure that needs to be built to support these plans. So, I'm really very excited to be part of that ongoing discussion.

AJMC: There are a few sessions on screening this year. How are community practices looking to up their screening game and close gaps?

Ajayi: ACCC has been at the forefront of screening. There's been a lot of work done with Elizabeth Cancer Center. They've done some really awesome pioneering work in screening, and it's something that's widely published; they're up for one of the Innovator Awards this year, and I'm going to be really excited to give that.

But I think the more important thing is that through their presentations, practices will learn what it really takes to have a sustainable screening program, to screen patients and develop relationships within the community to enhance that. For example, how practices can develop relationships with the primary care providers, how they can set up a team that will help with follow-up on patients who are eligible for screening? We all know that follow-up will dramatically improve success in getting patients to be screened. So that's really exciting!

The other piece of it, too, is that ACCC has been very forward-thinking in involving state oncology societies. Right now, we have 16 oncology societies in the rural Appalachian area that are taking the lessons and best practices from successful cancer centers and sharing with others on what it really means to have a robust screening program. We all know that screening saves lives and as practices, learn what works and what doesn't work and what really what works best. Only then can we improve our screening numbers and get more patients to screening.

AJMC: The oncology space has seen a lot of success with uptake of biosimilars, but payer decisions and requirements remain a major barrier. How are community practices navigating these challenges?

Ajayi: So, payer challenges continue to be an issue. There are issues where payers may prefer a reference drug over a biosimilar. In addition to that, we're also seeing a lot of instances where patients may need pharmacists to stock 2 or 3 biosimilars. And so that definitely has an impact on inventory, and it has an impact on the viability of running a practice.

I think what ACCC is doing and what community oncology practices are doing are they're beginning to engineer some of these processes into how we take care of patients. An example would be educating physicians. How do we get physicians information at the time of decision making with information they need to select the right biosimilar product? We're beginning to see a lot of practices either have cheat sheets for their physicians or in some cases engineer that into their electronic medical record (EMR) systems; that cues physicians and they are able to select the best product at a time for the patient. So, we're beginning to see more and more of that.

In larger practices where we may have pharmacies, we're beginning to see pharmacists play a bigger role, as physicians order the regimen, to automatically substitute with the best biosimilar at that point. I think we're beginning to see more and more of that as community practices have been able to manage through the use of biosimilars in clinical practice.

AJMC: With each year bringing new technologies and novel therapies, how are community practices working to incorporate those into their workflow?

Ajayi: There's been a big push to leverage technology to improve patient care. That was the theme of the last president of ACCC. With new technologies, such as artificial intelligence (AI), coming to market, leveraging technology becomes about decision support tools, as well as gaining operational efficiencies within a practice. We're seeing more and more of that.

For example, EMR companies, such as Flatiron Health’s OncoEMR, are beginning to incorporate decision support tools into the EMR that really help providers make the best choice for a patient clinically, based on the most current guidelines. We’re really excited to see more and more of this, particularly in areas where we all know oncology is an expanding field and a lot changes from day to day. Having providers be able to keep up with every single nuance of change is going to be an increasing challenge. As we begin to see things like Flatiron Assist that helps with this clinical decision support, I think that's great. We're beginning to see more and more practices incorporate that.

In addition to that, we're seeing practices looking at electronic patient-reported outcomes (PROs). PROs comprise one of the requirements of EOM. And practices are beginning to at least ask how to incorporate this tool in PROs. We've had quite a few practices begin to implement those into their workflows. And we think it's a good thing to have.

The other piece of it is AI. AI is going to be a big deal moving forward. AI has the ability to impact the way we practice. I think what we're seeing now is a lot of practices beginning to engage AI to watch for operational efficiencies in their practices. AI can help summarize meetings for you rather than spend all that time writing meeting minutes. We're seeing AI help draft letters to insurance companies as a result of a denial of a regimen rather than having people do that manually. Soon, we're going to be seeing AI more in prior authorization. So, the use of AI is limitless and it's an exciting field! And practices are beginning to look into this and share best practices for that.

And then the last piece, I would say, is infusion management. How do you manage your infusion center with patients coming in to ensure that you have less wait times and patients are well taken care of? We're beginning to see AI also helping this, and it has been really instrumental in getting that going in community oncology clinics.

AJMC: Being based in the community, how are ACCC member practices addressing disparities, health equity, and social determinants of health?

Ajayi: I think there are so many things when it comes to disparities and social determinants of health that practices are looking at. Thankfully, we're beginning to see more and more movement in reimbursing for navigation services. I think that's going to be a huge piece in really helping identify patients who may be in underserved communities.

But there are other things that practices are doing. We've had some practices that are now beginning to understand the value of community health workers and partner with community health workers in identifying patients who may be in need. Community health workers know that in underserved populations, the issue of trust usually is a major thing with health care systems. Community health workers really can play a major role in helping build that trust with the health care system.

The other piece of it, too, is there are many practices that are beginning to do things, particularly in the area of research, which is crucial in understanding what are maybe some of the inherent biases that health care providers might have or health care staff may have. How do we bring to light those biases, and how do we give them tools to overcome that so that we can be more successful with underserved populations? There's been a lot of work done around this. Just Ask! is a tool that ACCC developed that focuses on research and understanding the inherent biases people may have with certain populations and giving them tools to overcome that. So, we're beginning to see more and more of that. And I think that's really a welcome thing, as practices are beginning to adopt some of these things.

The third piece of it is giving practices tools and resources, just like I mentioned earlier. For example, practices are beginning to have best practices with screening and getting more involved in getting patients screened, because we know in most underserved populations, screening is our most powerful weapon. So those are some of the things that I'm seeing that practices are doing, and I'm highly encouraged by it.