Kathy Oubre: Witnessing Growing Cancer Survivorship Is a Privilege

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), will take place virtually on April 23 and 24. The American Journal of Managed Care^® (AJMC^®) recently spoke with Kathy Oubre, MS, chief operating officer (COO) of Pontchartrainn Cancer Center (PCC) in Louisiana, who will be a panel member on “Top Community Oncology Issues Now & Looking Ahead” and “Improving Practice Workflows & Prior Authorization With Robotic Process Automation.”

Click here to register for the virtual conference.

AJMC^®: What will you be discussing at COA's 2020 virtual conference?

Oubre: At this year's Community Oncology Alliance conference, I will be participating with other panelists to discuss top community oncology trends and issues, as well as improving practice workflows and prior authorizations through artificial intelligence.

AJMC^®: Why should individuals register for the conference?

Oubre: Whether virtual or in person, the annual Community Oncology Alliance conference is always a place for us to share ideas for improving patient care, discuss the unique challenges that we face, and ultimately advocate for community oncology.

AJMC^®: What do you see as the top oncology issues in light of the current COVID-19 atmosphere?

Oubre: So, at Pontchartrain Cancer Center, we definitely took advantage of that CMS 1135 waiver for implementing telehealth within our practice. Telehealth now accounts for over 50% of our E&M [evaluation and management] visits within the organization. It also allowed us to provide a more systemic approach to caring for our patients and minimizing the risk of exposure for our staff as well as our patients.

AJMC^®: You have been COO of Ponchartrain for close to 15 years. During that time, what have been the top developments in advancing survivorship care planning?

Oubre: Community oncology's understanding and knowledge of cancer continues to deepen. We recognize a greater awareness for the diversity as well as the growing needs of our cancer survivors. Originally 15 years ago, when you started talking about survivorship care, you really looked at it as starting that at the completion of therapy, and over the past several years, there's been that growing trend to begin those conversations at the beginning, and often even before the initiation, of therapy, because really you're a survivor from the day you find out you receive a cancer diagnosis.

Also, survivorship care planning traditionally focused on treating patients with curative intent. But now with the advances in cancer diagnosis, treatment, and therapeutics, specifically immunotherapy, we see a much larger growing population of patients with advanced disease who are living long after their cancer has stabilized. So those advances now create a greater need to expand our survivorship resources to evolve as information emerges on the need for long-term screening, surveillance, symptom management, and supportive care needs of those survivors.

AJMC^®: Your second session is on robotic process automation. Please tell us what exactly that is.

Oubre: So robotic process automation, or RPA, is a set of technologies used to automate otherwise manual work processes. What it does is it pulls basic patient information demographics, labs, and scan results from several places, such as your EMR [electronic medical record] and your practice management system, and it loads them into a single interface, which allows us to submit and track prior authorizations across multiple payers.

AJMC^®: And you have such a system at PCC right now?

Oubre: We do. We went live about a week and a half ago. And we've already seen a decrease in hands-on time needed by our staff, which has really come at a great time as we're in the middle of this COVID crisis. It allows our employees to now focus on higher-level tasks. And it's also been one of those "A-HA!" moments for us because we are in COVID right now, but we also are in a hurricane-prone area. So one of those things that we've learned is that healthcare has to be able to turn on a dime and keep moving. We can't just throw up our hands and stop working because of COVID, because of a hurricane, so automating these processes and having them in more of an electronic database allows us to work from anywhere.

In hurricane season, if we have to evacuate, as long as we have a secure network, we can continue those prior authorizations and continue those workflows. Or if someone is out sick, then someone else isn't scrambling and delving through all of those papers to find out where an authorization is. It allows any user from any location to log into a central system and continue those workflows.

AJMC^®: For that system, what are your longer-term goals going forward?

Oubre: Well, we've been really pleased already with what we're seeing from the prior authorizations. We would love to expand that maybe down the road into automating appointments, automating appointment reminders, interfacing even in a more sophisticated fashion with our payers, with our healthcare systems, and other providers.

AJMC^®: Can you please speak to trends in oncology as they pertain to telehealth and home infusion?

Oubre: Home infusion of chemotherapy, immunotherapy, or even supportive medications, raises really serious concerns about patient safety. Very often, a home infusion provider is not a trained oncology nurse and may not have the training to recognize or be prepared to treat an adverse reaction, which is common in oncology treatments. During this COVID pandemic, community oncology practices have really taken an abundance of appropriate safety measures to ensure the safety of our patients, such as closing our waiting rooms, using an abundance of personal protective equipment for our staff and our patients, as well as the use of telehealth to minimize the number of people entering the building at any given time. In all of this, is that concerted effort to provide patients we care for the safest environment possible.

Of the top community issues that we're going to be discussing next week, telehealth, we'll be talking about what we think CMS is going to do about telehealth moving forward after the pandemic, because it's never really been used before, because of that rural health component. So we all know that they're not going to be able to use it in its current form after the pandemic. But I think there's some really interesting takeaways from what we have learned in using telehealth. And I think there is a place for it in medicine moving forward; we're just not sure what.

There's a lot of concern about how COVID and this public health emergency is going to impact community oncology and those who are participating in value-based care. And that's something that we're in the middle of it right now. So we can't really discuss what that's going to look like yet.

One of the most interesting things that we've been doing during this public health emergency is we're becoming more of a one-stop-shop to take care of our patients. So many of them have been impacted by this crisis, whether they're in their homes all the time, for some of our older patients. Are they able to have access to the grocery store? Do they need help with transportation? Because that caregiver that they relied upon before now has to work an extra job or is not able to take time off to ensure that they don't lose that job. Are they able to pay their bills? We're doing a lot more in securing social and financial resources for our patients than we certainly did 3 or 4 months ago, and much more on a holistic level for that patient and not just taking care of their medical needs.

AJMC^®: With multidisciplinary care, which is what you're alluding to, you have to take care of the whole patient, not just their cancer, because it affects all aspects of their lives.

Oubre: And it's not just their life. It's the caregivers, the family. A lot of us have developed resources and programs specifically for spouses, caregivers, and children. Something else that we're seeing an abundance of need for right now also is mental health services. We've become kind of that repository in helping being that connector and helping connect our patients or their family members with mental health services within the area.

People ask us all the time, “How do you do what you do? It must be so sad, and it must be so depressing.” And, you know, the thing is, it's not. It's a privilege to be able to get out of bed every morning and come to this office with the purpose of being a witness to patients during their cancer journey. We have good outcomes, we have bad outcomes, but it is a privilege to be part of that process. And to witness the bravery, the strength, the resilience. They're fighters. And I enjoy every day being able to be part of that. Sometimes the outcomes are not great, but even being able to be part of that process of closure and peace, that's a very intimate and life-changing relationship.

It is. It's a privilege to do what we do. It's not a burden. Sometimes it's sad. If it were never sad, then we wouldn't be doing our job right. But sometimes, and most of the time, almost all the time, it's extremely rewarding. I love what I do.

AJMC^®: Thank you for doing what you do and taking care of so many.

Oubre: You're welcome. Absolutely. It's true.