How Do Infusion Pharmacies Support Financial Sustainability in Oncology?

With rising oncology treatment costs and potentially billions of dollars anticipated in health care cuts, providers must optimize infusion pharmacy services to navigate reimbursement challenges, says Jorge García, PharmD, MS, MBA, MHA, FACHE, FACCC, assistant vice president of system oncology pharmacy services and system infusion pharmacy services at Baptist Health South Florida.

In an interview with The American Journal of Managed Care® (AJMC®), García notes that value-based care in oncology has faced challenges, but sees emerging models as promising strategies to align cost containment with quality care.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

With rising treatment costs and reimbursement challenges, how can infusion pharmacy optimization help cancer centers improve financial sustainability while maintaining high-quality patient care?

When I think about high cost in oncology, the large majority of the pharmacotherapy services that we provide our patients do take place on the outpatient setting. That is a buy and bill setting. I think the dynamics there is a little bit different than when we consider services on the inpatient setting with a DRG [diagnosis related group] kind of payment.

For me, it's really important to identify best practices establishing access in both of those settings, and that requires a slightly different approach and a strategy to make sure that it is sustainable and that it could be done in a viable way. But we continue to see in the cancer care space viable avenues to support the services.

I think as we move into the near future, we know that there are expectations to cut health care costs. I think we're socializing a number of around $800 billion in cuts, so that is little bit concerning. Understanding how much of that may come out of Medicare reimbursement, other CMS services, [or] potential Medicaid eligibility is something that we need to continue to track very closely to understand how it's going to impact our patients and our practices going forward.

How can infusion pharmacies align with cost-containment efforts set by value-based care models without compromising treatment access?

I think we've talked about value-based care in oncology a long time, with somewhat limited success. I think value-based care has found its way into chronic conditions, hypertension, diabetes, and others.

I think in oncology, just given the nature of oncology, the outpatient nature of it, it's been a little bit more challenging. But I begin to see some value-based [and] some at-risk sort of arrangements that make a lot of sense in oncology, especially around high-cost pharmaceuticals, where you would see either the life science organization provide a credit for the drug if the clinical outcomes are not met for that patient, and I think that that's tremendously helpful for some of the therapies. But also understanding how the health plans may be able to partake in the risk of a therapy that may be provided to a patient where the patient may not be achieving outcomes.

I think we're just beginning to understand how this fits in in oncology with some few examples, but I think we're going to continue to make progress in this space to ensure that as stakeholders that participate in cancer care—the provider, the health plan, the life science organizations—we're all invested in the success of therapies. I'm excited to see what's in store there as we continue to go into the future.