The US Oncology Network recently reached a major milestone of enrolling its 100,000^th patient in the Centers for Medicare & Medicaid Innovation’s (CMMI) Oncology Care Model (OCM).  This momentous milestone is a result of the hard work and commitment from participating practices dedicated to delivering high-quality patient care.

Since the program’s initiation in 2016, participating practices in The Network have delivered more than $122 million in cumulative savings to Medicare over the program’s first six performance periods (PP), decreased emergency room visits by three percent, reduced hospitalizations by seven percent and increased hospice utilization by five percent. Practices across The Network are performing well in the OCM, and most continue to show improvement each performance period.

How practices in the OCM are enhancing the patient experience and services
Since the inception of the Oncology Care Model, practices have made several enhancements to their operations to improve the patient care before, during and after treatment.

• Enhanced treatment planning and shared decision making at the start of each treatment

Practices in the program utilize a shared decision-making approach to create treatment plans for each patient. Through comprehensive pre-treatment education, patients are informed about potential side effects and key contacts within the practice they can reach out to for concerns.

• Increased support through patient navigation and social work

Patient navigators and social workers play a key role in helping patients access clinic and local community resources. Physicians collaborate with their team of patient care coordinators, nurse navigators and medical assistants to ensure quality patient care is delivered.

• Increased adoption of team-based care and huddles

Practices have adopted team huddles to proactively identify and help at-risk patients. This enables physician teams to provide closer surveillance and schedule a visit focused on goals of care with the practice’s social worker.

• Improved access to care with Call Us First campaigns, proactive high-risk outreach, improved triage, electronic patient reported outcomes, and same day/next morning urgent care access

Practices have increased their availability to provide same day or next day urgent care access to help patients avoid emergency room visits and in close contact with their physicians and care teams.

How The Network supports practices in the OCM
The US Oncology Network remains committed to providing comprehensive, proven resources and support to help practices navigate the OCM and successfully transition to value-based care programs. These resources include industry-leading technologies that drive evidence-based decision-making at the point of care, advanced analytics for optimal data management and reporting, and innovative pharmacy solutions for efficient drug management. The Network also provides practices access to subject matter experts who have deep knowledge in the OCM and value-based care.

Congratulations to value-based care teams across The Network on this significant milestone and thank you for all that you’ve done to support the oncology patients that you serve.

 

ABOUT THE AUTHOR Stuart Staggs, the senior director, strategic programs is responsible for partnering with community oncology practices in The US Oncology Network to support their performance and the adoption of the Oncology Care Model (OCM) and Merit Based Payment System (MIPS).

 

This month, we celebrate American Pharmacists Month and recognize the critical role pharmacists play in oncology practices and patient care. From standing on the frontlines during the pandemic, to ensuring proper medication therapy management and bridging the gap between patient and provider communication, pharmacists in The US Oncology Network play a vital role in providing quality care to cancer patients.

Bringing value to practices

Pharmacists, along with physician researchers, help practices stay abreast of cutting-edge drug treatment options and regulations impacting the field of pharmacy. Cancer care can be costly, but by managing performance-based contracts and securing drug rebates, pharmacists are able to help offset costs to support the financial health of the practice.

In addition to providing patient medications, pharmacists and pharmacy technicians ensure a high level of safety with drug management. From compounding, preparing, and dispensing chemotherapy infusions, they ensure that patient care and safety is a top priority and compliant with all regulations and aligned with industry standards.

Improving patient care

From drug consultations to patient follow-ups, The Network pharmacists help support patients and providers to optimize cancer care. Pharmacists engage in multiple touch points with patients through prescription counseling, medication adjustments and side effect management. In-practice pharmacists are a part of the patient’s collaborative healthcare team and provide patient access to drug treatment information, financial support and educational resources.

Through collaboration with physicians, nurses, social workers and healthcare advocates, pharmacists in The Network are an additional resource available to patients to help them understand the scope of treatment options from costs, to drug availability, to side effects and provide additional resources. Pharmacists also follow-up with patients on oral medications to check for adherence, determine dosage adjustments and provide clinical updates to physicians when necessary.

During this unprecedented year due to the pandemic, pharmacists and pharmacy personnel have stepped up to make sure patients continue receiving life-savings medications and treatments. With the increase in telemedicine appointments and reduced in-office visits, pharmacists have had to quickly adjust to changing patient demands to ensure they receive their prescribed medications quickly and safely.

The future of pharmacy

As cancer treatment options become more personalized, the role of pharmacists continues to evolve to encompass all phases of patient care and support clinical decision making. With recent advances in precision medicine and clinical trials, there are many new opportunities to leverage the medication expertise of pharmacists. Pharmacy teams are an integral part of patient care and are equipped to be change leaders in the field of oncology.

Within The US Oncology Network there are over 90 pharmacists working tirelessly to support practices and patients. We thank you for your service and standing on the front lines to provide comprehensive cancer care in the community.

ABOUT THE AUTHOR  Derek Burns, PharmD, BCPS, BCSCP, DPLA is the Director of Pharmacy and Admixture Services for Rocky Mountain Cancer Centers (RMCC). He is responsible for overseeing all aspects of pharmacy operations and strategic growth development for RMCC.

New advances in precision medicine are rapidly altering the way physicians diagnose and treat cancer. Biomarker testing that factors in a patients’ genomic and cellular profile mean truly customized treatments are closer than ever before.

These major advancements in precision medicine are attributed to next-generation sequencing (NGS), a new laboratory technique for evaluating molecular sequences that can analyze millions of DNA mutations simultaneously. Through this new sequencing method, data is collected and leveraged for updated biomarker testing recommendations, patient care models, disease screening protocols, and treatment guidelines from professional medical societies – all of which can be used by physicians to make informed decisions on the most personalized and effective ways to treat cancer for each individual patient.

While these innovations are exciting, there are challenges and hurdles that many oncologists face.  Physicians must choose from an array of complicated tests to make a diagnosis and create a treatment plan for their patient in a timely manner. Testing and evaluating data can be a burden to manage, but through advancements in iKnowMed^SM Generation 2, McKesson’s leading oncology EHR, and access to top laboratory vendors, physicians in The Network can more easily navigate the complexities of precision medicine to provide better care for patients close to home.

Making precision medicine easier for practices

The US Oncology Network is committed to making precision medicine easier for physicians and has built tools to ensure their success.

• Vetted biomarker testing labs

To ensure quality results, a comprehensive list of vetted labs is embedded in our biomarker order guides, eliminating the need for physicians to find their own reliable testing source. Labs are evaluated by The Network’s biomarker committee consisting of physicians who examine each lab to determine their sustainability, quality and breadth of testing, and financial assistance programs.

• Comprehensive biomarker order guidelines

To eliminate the guesswork of identifying appropriate tests and treatment options, comprehensive biomarker order guidelines are embedded in iKnowMed^SM Generation 2. This feature is frequently updated to keep up with the latest developments on biomarker discoveries and new drugs.

• Auto-populated forms to streamline biomarker test ordering

To save time manually entering patient information and completing vendor forms, iKnowMed^SM Generation 2 includes an interactive auto-populating feature. This feature automatically populates the correct lab vendor order form with the patient’s information once the appropriate test is chosen.

Through efforts to continue to enhance the diagnosis and treatment of cancer patients, The US Oncology Network is proud to make precision medicine a standard of care for all patients with advanced cancers.

 

ABOUT THE AUTHOR  Jen Buhay, PhD, is the precision medicine clinical program manager for The US Oncology Network, leading biomarker testing, education, and operational efforts to support personalized patient care for oncology. She is board-certified as a molecular biologist through the American Society for Clinical Pathology.

Oncology practices are constantly evolving and navigating changes in the healthcare landscape. While the increasing complexity of administrative and operational responsibilities can bring about unforeseen burdens, The US Oncology Network’s technology implementation services and support help ease those challenges. Our team leads the implementation of processes and tools that enable our physicians to focus on delivering leading edge care to patients.

Building a technology roadmap and supporting implementation

The right technology is critical to operating a successful practice. Our deep understanding of oncology practices drives the development of an individualized technology roadmap that serves as a plan for practices to navigate the implementation of our industry-leading technologies to support core clinical, operational and financial aspects of the practice.

Appropriate technology solutions are determined after discussing practice strategy and identifying gaps in patient care and practice efficiency. We work with practices the find the right solution from our portfolio of solutions and work with vendors to seek additional solutions to ensure we are truly solving practice problems. As practice needs evolve and new solutions become available roadmaps are modified to support continuous practice improvement.

 

Supporting practices through implementation

Technology projects are managed from the initial set-up to training and on-going support. Our team of project managers work closely with practices set timelines, coordinate meetings, manage communication and serve as a liaison to vendors to avoid the interruption of daily practice operations. A technology dashboard is easily accessible to keep practices up to date with ongoing projects and their technology roadmap.

 

Successful oncology practices navigate the evolving healthcare landscape with a well-planned roadmap to guide technology implementation to ultimately help practices treat patients and have better patient outcomes. As measures assessing cost, quality and other outcomes continue to evolve, the right technology is critical to meeting demands.  Our technology allows the providers in The Network to focus on the health of their patients, while our focus is on the health of their practices.

 

ABOUT THE AUTHOR

Theresa Gray is the Senior Director of Network Technology for The US Oncology Network. Theresa is responsible for leading technology strategy and implementation for The Network while ensuring alignment with the broader strategies of The Network, to drive profitable and sustainable network growth. Theresa has been with the organization for over 30 years.

 

As the COVID-19 pandemic continues to make an impact across the country, The US Oncology Network is committed to ensuring that community oncology practices have the resources and tools necessary to navigate these stressful times. Even those who are typically strong and resilient in crisis situations can experience intense fear and anxiety about the unknown.

To support physicians and practice staff holistically during these unprecedented times, The Network offers helpful tools and information on Self-Care and Resiliency to assist with easing day-to-day stress and maintaining the well-being of physicians, practice staff and their families. Resources include podcasts, apps, websites and videos with topics ranging from practical ways to incorporate self-care to adapting to situations to balancing new routines are available.

Tips for self-care

To stay mentally strong during stressful times and times of uncertainty, consider incorporating the following tactics into your daily life:

• Self-Care Activities – Discover practical ways to demonstrate self-compassion and mitigate compassion fatigue by taking time for yourself. Take time to listen to music, read a book, exercise or go for a walk.
• Practicing meditation, mindfulness and yoga – Calming the mind by redirecting focus and physical movement are powerful methods to reduce stress. Use apps and virtual tools designed to ease tension and promote relaxation.
• Listening to podcasts – Get relevant information and feel connected, whether you’re on the go driving or sitting in your office. Listen to audio programs that share expert insights and relatable coping strategies.
• Engage in family activities – Times of uncertainty prompted during a health crisis can impact the entire family. Implement new strategies for parents and caregivers to address the sensitive needs of children and incite engaging activities.
• Find balance while working from home – Working remotely can be a challenging and uncomfortable lifestyle change for some. Use resources that provide ways to stay productive while still caring for your mental well-being and finding balance.
• Explore financial and debt relief assistance – The economic impact of the COVID-19 pandemic has taken a financial toll on many families. Learn about programs offered through the government and other financial institutions that may provide some relief during these challenging times.

While balancing increased job demands, caring for patients and families during these unprecedented times, it is important for physicians and practice staff to manage their own mental health and well-being. Everyone must remember to take care of themselves in order to take care of others.

About the Author
Lydia Mills, MSW, LCSW, LICSW is the Senior Manager, Palliative Care and Social Work for The US Oncology Network. In this role she supports Network practices in their palliative care, advance care planning, and end-of-life initiatives, as well as working with and supporting the social workers across The Network.  Given her clinical social work background, she also has a passion for encouraging and promoting self-care.

Celebrating Oncology Nursing Month in 2020: The Year of the Nurse and Midwife

Every May, we celebrate Oncology Nursing Month and recognize the critical role oncology nurses play in patient care. This year’s Oncology Nurses Month is of additional importance because 2020 is designated The Year of the Nurse and Midwife by the World Health Organization (WHO) in commemoration of Florence Nightingale’s 200^th birthday. Further, it is the culmination of their three-year Nursing Now! campaign to elevate the status and recognition of nurses worldwide.

Every day oncology nurses deliver steadfast care to cancer patients by explaining diagnoses, providing education, administering critical treatments, coordinating care, celebrating victories, consoling during disappointments and so much more. This important role is especially critical during the current global crisis. Despite the threat to their personal health, oncology nurses everywhere have provided essential care, treatment and support for patients trying to navigate their cancer diagnosis in the face of the COVID-19 pandemic.

The US Oncology Network supports nurses year-round

The Network recognizes the important role nurses play in providing the highest quality patient care in a community setting and we are committed to supporting the professional growth and development of all our nurses and clinical staff.

Through our collaboration with the Oncology Nursing Society (ONS), nurses in The Network have access to clinical education programs, various certification courses, including the ONCC FreeTake^TM Certification Program. In addition, they have access to leadership courses and other learning resources to further their educational opportunities.

We celebrate you

In recognition of Oncology Nursing Month, we would like to take a moment to turn our thoughts especially to the dedication and compassion of nurses in The Network. You represent the best of oncology nursing and the Florence Nightingale legacy! Thank you for what you do to support and deliver the best care possible to patients today and every day.

As the COVID-19 pandemic continues to make an impact across the country, The US Oncology Network is committed to ensuring that community oncology practices have the resources and tools necessary to navigate this crisis. Through telemedicine support, IT, human resources, best practice sharing and communications we are committed to supporting practices to ensure they can continue to care for their patients during these unprecedented times.

We are diligently working on innovative strategies to support practices and their teams. Our COVID-19 task force continually monitors and evaluates to situation. Our decisions are based on recommendations from the Centers for Disease Control and Prevention (CDC), the American Society of Clinical Oncology (ASCO) and other federal, state and local agencies.

Communication with practices and patients

We have prioritized communication with The Network to ensure practices have the most up-to-date information. Weekly meetings with practice leadership and physicians are in place to provide updates and a forum to share ideas and collaborate. In addition, communication guides and templates help practices communicate with patients, staff and the media during this crisis.

To help providers communicate with their patients, we quickly launched a telemedicine solution that allows patients to continue to receive care without having to leave their home. With relaxed regulations around telehealth during this time, visits are covered by payers making it an alternative to visiting the clinic. Since the launch of the telemedicine solution, practices in The Network have had more than 6,000 visits across nearly 1,200 providers.

Breaking down federal and state relief bills for community oncology practices

Our government relations and public policy team is helping practices break down and understand federal and state level COVID-19 legislation such as the Coronavirus Preparedness and Response Supplemental Appropriations Act, Families First Coronavirus Response Act, and Coronavirus Aid, Relief and Economic Security (CARES) Act. Through webinars and summary documents, The Network practices learn about the impact of these bills on their practices and patients quickly. The latest information on The Network’s advocacy efforts, federal support for physician practices, executive orders, and legislation in response to COVID-19 is available on Legislink.com.

During this time, it’s paramount that practices have access to tools and resources necessary to deliver care to cancer patients. Providing those resources and support is our top priority now in a time of crisis and into the future.

Proton therapy is an advanced radiation therapy that uses protons to treat cancer rather than x-rays. Protons deliver the majority of their energy directly into the tumor and stop, minimizing exposure to adjacent healthy tissue. X-rays used in standard radiotherapy continue through the tumor, exposing patients to unnecessary radiation that can result in both short-and long-term side effects and secondary tumors. 

Proton therapy was approved for cancer treatment in 1988, but was not commonly used due to the high cost of developing proton centers. Development costs have been greatly reduced, and today there are 29 centers across the country. The technology is evolving as more research is conducted and we discover more and better ways to use the therapy. During my several decades of working with proton therapy, I have had the opportunity to play a role in some of the advancements that have occurred. One such development that holds great potential for cancer treatment is pencil-beam scanning. This technology provides greater conformality in tumor treatments compared to traditional proton beam therapy, enabling us to treat patients today that we previously had to turn away. In spite of the promising advancements being made and the decreased development costs, proton therapy remains controversial because treatment costs are higher than conventional radiotherapy. 

A closer look at the benefits

Critics often contend there is little evidence to support the cost of proton therapy, but there are many credible clinical studies that show substantial benefits to patients. Additionally, when considering the value of proton therapy, there is more to examine than just the initial cost of treatment. Ongoing expenditures for treating side effects, as well as the patient’s quality of life, must be considered. Managing toxicities, both short-and long-term, is expensive and can be a financial burden to patients and other stakeholders. Patients also want the best quality of life possible so they can enjoy their survival. Proton therapy addresses both of these concerns, minimizing costly side effects while improving quality of life.

Another issue to consider is that lifespans are increasing and many patients are living several decades beyond their treatment. During that time, many experience another episode of cancer. Approximately one in 12 adults diagnosed with a common cancer will eventually develop a second cancer unrelated to the first.1 Patients eventually reach a point where they cannot tolerate any more treatment in their lifetime, so managing the second cancer becomes problematic. Proton therapy can control the initial cancer while minimizing treatment toxicities, offering an avenue to more effectively treat a second cancer if one occurs.

Finally, as more cancers are cured, we will have many more survivors. The increasing number of these patients and the potential costs of treating side effects on a larger scale will dramatically impact our limited healthcare resources. It will be essential to minimize the consequences of cancer treatment while still supporting optimal outcomes. Proton therapy can play a vital role in achieving that objective.  

Investing in optimal outcomes and quality of life

While we are all concerned about costs, we shouldn’t invalidate a treatment that may initially be more expensive but can provide substantial cost savings, improved outcomes and a better quality of life in the long run. It is time to recognize the many benefits proton therapy provides over the long-term, rather than just focusing on the here and now. 

 

1. https://www.medscape.com/viewarticle/866433

Approximately 90% of oncology patients require a complete blood count (CBC) when they visit their oncologist for the first time. The CBC is used to evaluate a patient’s overall health and detect a wide range of disorders, including anemia, infection and leukemia.1 The test is especially critical in oncology, where cell counts can help guide important and time-sensitive treatment decisions, including whether to start or stop chemotherapy, identify if a patient needs a blood transfusion, or to make sure a patient’s bone marrow is functioning properly. In fact, nearly 70% of clinical decisions, including diagnosis and treatment, are based on CBC results.2

On-site lab allows for convenience and speed

For patients, an appointment with an oncologist can be daunting and stressful. To alleviate some of the stress, offering a “one-stop-shop” where patients can meet with their physician and also get bloodwork done in a matter of minutes allows for a more convenient and positive patient experience where important treatment decisions can be made on the spot. Without an on-site lab, patients are required make several stops, wait for results, and only then can they follow up with their oncologist – taking more time than necessary.

Key benefits of on-site labs

In addition to speed and convenience, on-site labs offer five key benefits:

1. Direct supervision over quality and cost decreases operating expenses.
2. Less pre-analytical handling of blood specimens reduces errors that can cause inaccurate results.
3. Follow-up testing can be easily added to an existing blood sample without having to redraw.
4. Consistent reference ranges mean decreased interpretation errors.
5. Many research clinical trials require pre- and post-dosage test results.

There are approximately 250 on-site labs in practices across The Network, and each lab is equipped with top-of-the-line clinical laboratory services. Lab test menus vary in complexity from CBCs to Flow Cytometry and other esoteric testing.

On-site labs play a vital role in value-based care

The Network helps practices achieve significant and measurable cost savings for on-site labs. Savings are partially realized through low standard pricing for equipment and reagents, which ultimately reduce overhead costs by decreasing internal cost. This is critical as the health care landscape shifts to value-based medicine and adopts a model of payment for a treatment, rather than for an individual visit or service.  

The US Oncology Network Laboratory Team is currently working on several initiatives to support affiliated practices, including recent updates to administrative and regulatory standards, all of which are readily available for practices through an internal portal.

Given the importance of lab testing to a patient’s treatment plan and outcome, having an on-site lab in today’s health care landscape benefits physicians, patients and payers.

 1. https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/p…

2. https://www.mayo.edu/mayo-clinic-school-of-health-sciences/careers/labor…

By Marcus Neubauer, MD   |   July 2018

Since July of 2016, roughly 187 oncology practices across the country have been participating in the Oncology Care Model (OCM), the Center for Medicare & Medicaid Innovation’s (CMMI) new program designed to reduce the cost of care while improving quality and patient outcomes. Sixteen practices in The US Oncology Network (The Network) are participating in this care delivery/payment model, providing enhanced care to thousands of Medicare patients.

The Oncology Care Model is a very complex program, and there is a definite learning curve for practices trying to implement it. From input gathered so far across The Network, as well as from my own experience with the OCM, there are some critical activities that must be performed well to ensure success with the program.

Key Activities when Participating in the OCM

Initially, practices must determine which patients are qualified for the program. Identifying patients is challenging, especially those patients who are only on oral drugs, and workflow changes within the practice must be implemented to pinpoint eligible patients. Once patients are enrolled, practices must then bill for the monthly-enhanced oncology services (MEOS) CMS pays to fund the program. New processes and procedures will be needed to ensure all MEOS payments are billed and collected to support the special services being provided.

MEOS payments must be utilized to fund the enhanced care practices are required to deliver according to terms of the program, rather than being used for other purposes. Medicare refers to this as appropriate cost resource utilization. Data must be submitted to verify how the money is being spent, including information about new hires that are critical to the OCM, as well current employees who are spending time on the program.

Performing well on all quality metrics and reporting the data are key activities of the OCM. Practices must report their performance data through the OCM portal, submitting detailed information about each enrolled patient. Practice performance is also judged on quality measures drawn from CMS claims data. The quality measure relating to the practice’s ability to keep patients out of the hospital is critically important, and practices must excel on this metric to succeed with the program.

Practices must also pass inspections by CMS and be prepared for close-up scrutiny. The agency may conduct on-site visits and detailed audits to ensure program rules are being followed. Many of the OCM requirements are designed to drive and support optimal outcomes, so it is critical for the practice to adhere to terms of the program. Practices that do not meet all requirements may be removed from the OCM, even if they are performing well in other areas.

Appropriately managing and reducing the cost of care is undoubtedly the most crucial activity that must be done well, as controlling costs is a major goal. The program is under close observation by CMS and CMMI to evaluate whether or not the model design can drive better care and outcomes at a reduced cost. Practices that have high performance scores in other metrics but report exorbitant costs will not succeed.

Activities help practices transition to value-based care

Excelling in these key activities can help ensure success in the OCM, while also providing a strong foundation for value-based care, overall. While the OCM is a five-year pilot project ending in 2021, value-based cancer care is not going away. The government is focused on driving value in healthcare, so programs like the OCM will only become more commonplace. To thrive in this new environment, practices must adapt by transforming their organizations to meet the needs of this new way of delivering care.

By David C. Fryefield, MD   |   June 2018

Radiation oncologists have been operating in a very challenging landscape for quite some time―one that has created unpredictable revenue streams for providers and made the delivery of quality care more difficult. Providers are under pressure from payers to reduce the number of treatments based on clinical trials demonstrating fewer treatments are as effective as a larger number in certain cancers. Innovative technologies are now part of the radiation oncologist’s toolkit, but these advances are driving up costs. As a result, prior authorization requirements and denials have greatly increased, dramatically impacting revenue and hindering the timely delivery of quality care.

New Payment Models Reduce Uncertainties

To drive greater value in cancer care and provide more predictability to providers, payers and patients, The US Oncology Network (The Network) has developed several alternative payment models (APMs) for radiation services. These new value-based APMs focus on private payers, since roughly half of a practice’s patients may be covered by private or commercial insurers. While reducing the uncertainties around treatment authorizations and reimbursement, these APMs also more closely align payments with the care patients actually receive.

Several practices in The Network already had APMs up and running while our models were on the drawing board, providing valuable insight into how various APMs actually perform. Drawing from this hands-on experience and the collective expertise and resources of The Network, two APM models were created, both of which transition from the traditional fee-for-service model to more predictable episode-based bundles.

The Episode of Care Model

The episode of care model offers flexibility, as it can be designed either as a disease site/stage-based model or a modality-based platform. The disease site/stage-based framework provides prepayment for a defined single episode of care based on the disease site or stage. The modality-based model provides prospective payment for an episode of care utilizing case rates based on various technologies, including 3D conformal therapy, IMRT, SRS/SBRT, and HDR/LDR brachytherapy.

The Capitated Payment Model

Less prevalent across The Network with practices already using APMs, the capitated model shifts more risk to providers for patient care, paying them on a per member monthly basis for services provided to a specific payer population.

There is a definite learning curve when implementing these new models, and The Network is assisting affiliated practices with various levels of support. A comprehensive playbook has been developed to guide practices in determining which models are the best fit for their practice. Risk mitigation strategies are also presented, along with information on evaluating APM opportunities and the readiness of the practice to implement the new models. Ongoing assistance is also provided to help practices succeed as they encounter challenges along the way.

Creating Our Own Future

While we cannot control the evolving environment we currently operate in, we can control how we respond to it. Value-based care is here to stay. Consequently, we have much to gain by developing our own value-based models that better serve all stakeholders, rather than waiting for less than optimal models to be forced upon us. While it is too early to draw definite conclusions about whether these new APMs will be successful, they are, nevertheless, a great start on our journey to value-based care for radiation services. Not only do they support the timely delivery of high-quality care and realign incentives in a more equitable way, they also provide valuable real-world experience that can drive improvements in future models.

Those of us in the cancer community know that progress in the fight against cancer is often measured in very small steps. Certainly since I finished my fellowship, that has been the case. Over the last 30 years, treatment for many deadly cancers has usually involved substituting one chemotherapy drug for another, buying a patient time while increasing the cure rate by a mere percentage point or two.

However, cancer research has finally taken a giant leap forward with a powerful new immunotherapy, chimeric antigen receptor (CAR) T-cell therapy. This exciting new therapy has demonstrated phenomenal results for certain hematologic cancers, while offering the promise of better outcomes for many other cancers in the future. Patients previously considered terminal are now in remission with good quality of life demonstrated for up to five years.1 Many of these patients look like they are going to be cured, as survival curves plateau after two years.  The therapy is currently approved for use in relapsed diffuse large B-cell lymphoma (DLBCL), and pediatric acute lymphoblastic leukemia.

The treatment is quite complex. Thousands of the patient’s T-cells, a type of lymphocyte, are extracted from the patient’s blood. The cells are then reengineered in a laboratory using a viral vector, transforming them into cells that attack the CD19 antigen in cancer cells. Millions of these genetically modified cells are then produced in a laboratory. After undergoing lymphodepleting therapy, the programmed lymphocytes are then infused back into the patient. CAR T-cell therapy is often referred to as a “living immunotherapy” because the cells continue to multiply on their own, taking up to three months to reach maximum response.

Centers offering the therapy must be certificated and staff must receive special training to ensure they understand how to administer the therapy and identify and manage possible side effects, which can rapidly become life threatening if not treated promptly.

Bringing CAR T-Cell therapy to local communities

The US Oncology Network (The Network) is very excited about this promising therapy, and presently several practices in The Network are investing in the extensive training required to offer this innovative treatment. The Network is also working with CAR T-cell manufacturers to participate in the next clinical trials. The first such trial is for patients with relapsed DLBCL who are not candidates for an autologous stem cell transplant. The participants will be over age 70 or have other comorbidities. We hope this will be a very promising treatment option for these patients who are not considered fit enough for a transplant, which previously was the only proven curative therapy.  

Presently CAR T-cell therapy is only available in a few centers around the country, many of which have waiting lists. Unfortunately, many patients simply cannot endure the burdens that traveling for treatment often present, so they have no access to this lifesaving therapy. The goal of The Network is to dramatically increase accessibility, bringing CAR T to selected practices in local communities so patients can be treated close to home.

CAR T is a very exciting development that is rapidly changing the treatment landscape. Before giving up on a patient, I encourage all physicians not familiar with CAR T to check with a CAR T treatment center to see if it is appropriate for their patient, as today there is new hope where before there was none.

1 https://www.cancer.gov/about-cancer/treatment/research/car-t-cells