By Diana Verrilli | November, 2017
Over the last several years, many promising new cancer therapies have come to the forefront. The pipeline of new cancer drugs has never been richer, and exciting new developments in radiation technologies are providing new innovative treatments that are more precise and effective than ever before.
Unfortunately, these potentially life-saving therapies come with a very high price tag. For instance, Opdivo, a drug that treats certain types of lung cancer after conventional chemotherapy has failed, costs about $150,000 for the initial treatment, and then $14,000 a month for ongoing therapy.1 The yearly outlay for Keytruda, an immune boosting therapy, totals over $152,000.2 New cancer drugs will be even more expensive in the future, as drug costs are projected to grow 7.5 % to 10.5 % annually through 2020.3 The price could easily reach several hundred thousand dollars for a course of treatment for many of the new drugs currently in clinical trials.
In 2014, the average annual cost of treatment for cancer patients was $58,097.4 As treatment costs rise, hundreds of thousands of patients are delaying care, cutting pills in half or skipping drug treatment entirely. A recent survey found one-quarter of all patients opted to not fill a prescription due to cost.5 Treatment costs can be astronomical for patients without insurance, and even those with insurance struggle to afford high copays, out-of-network care or treatments not covered by their plan.
The financial costs of cancer care are a burden on the healthcare system as well. A 2011 study in the Journal of the National Cancer Institute determined the cost of all cancer care in the U.S. totaled $124.5 billion in 2010,6 the most recent year data was available. National Cancer Institute researchers project the total cost of all cancer care in the U.S. will rise to $157.7 billion by 2020 due to increasing drug costs and a growing elderly population that is more likely to develop cancer.7 These escalating costs are taking a heavy toll on a healthcare system with limited resources.
The Solution: Cost-Effective, High Quality Community-Based Cancer Care
A multitude of clinical studies have verified cancer care delivered in a hospital outpatient department costs significantly more than care delivered in a community setting, without providing any meaningful improvement in quality of care or outcomes.8
The differences between chemotherapy costs in the two settings are striking:
- Private payer costs for chemotherapy in hospital settings were 76% higher than freestanding community cancer clinics9
- The average cost of an office-managed chemotherapy episode was roughly $28,200 while the average cost of a hospital-managed episode was $35,000, more than a 24 % difference10
- Medicare costs by site-of-service were $6,500 higher annually for chemotherapy treatment in outpatient hospital cancer facilities versus independent community cancer clinics11
- Between 2009 and 2012, Medicare beneficiaries paid $4.05 million more in out-of-pocket costs for chemotherapy services in a hospital setting than they would have paid for the same care in a community cancer practice12
A recent study found the cost of radiation therapy in hospitals versus freestanding community-based radiation oncology centers is also higher for the patient. For instance, for prostate cancer patients undergoing IMRT therapy, costs were $3,097 higher in the hospital setting than for the same therapy in a freestanding clinic.13 Three-dimensional conformal radiotherapy for breast patients was $600 higher in the hospital, while treatment for lung cancer with this same technology was $430 higher.14
Community Cancer Care: Better Value―Better Care
Community-based cancer care is a better all-around value for patients, payers and the entire healthcare system, providing many other benefits in addition to cost savings. Conveniently located in local communities where people live and work, patients do not have to travel long distances for access to some of the most advanced technologies, treatments and groundbreaking clinical trials available today. The close proximity to care also reduces ER visits and hospital admissions.
Community centers offer more personalized care than large hospitals, with care provided by one team of professionals who become familiar to the patient. In the hospital setting, patients often see different physicians, nurses and technicians throughout treatment. Community cancer centers also provide convenient access to ancillary support services, such as social workers, financial counselors and other support staff.
At a time when cancer care costs are rapidly rising and becoming unsustainable to the healthcare system, community-based cancer care is the clear choice for patients, providing better value while delivering advanced, comprehensive quality care close to home.
1 https://www.healthnewsreview.org/2015/12/opdivo-ads-vs-the-reality-of-stage-iv-cancer-treatment/
2 http://www.benefitspro.com/2016/05/10/the-role-of-critical-illness-insurance-in-the-new
3 http://www.cbsnews.com/news/the-ever-escalating-cost-of-cancer-drugs/
4 Ibid.
5 https://www.ncbi.nlm.nih.gov/pubmed/23442307
6 www.drugwatch.com/2015/10/07/cost-of-cancer/
7 Ibid.
8 MedPAC to report to Congress, June 2013
9 www.communityoncology.org/pdfs/avalere-cost-of-cancer-care-study.pdf
10 Ibid.
11 http://us.milliman.com/uploadedFiles/insight/health-published/site-of-se…
12 Berkeley Research Group, Impact on Medicare Payments of Shift in Site of Care for Chemotherapy Administration, June 2014
13 Avalere analysis of 2012 5% Medicare Outpatient Claims file. Any visit with a CPT code for radiation oncology was included. Analysis uses payments and packaging policies for 2014 and 2015P, and includes physician payments in both settings
14. Ibid.
By Neelima Denduluri, M.D. | October, 2017
In my career as a medical oncology and breast cancer specialist, I have seen great advancements in the treatment of breast cancer with innovative new drugs and therapy. The outlook for breast cancer patients has never been better, as promising new developments are leading to more effective preventative strategies and late-stage treatments.
Over the last decade, we have seen dramatic advancements in treating many different forms of breast cancer, from early onset to late-stage diagnosis. Progress has been made with estrogen receptor breast cancer using aromatase inhibitors and tamoxifen, or fulvestrant, to regulate the estrogen signaling pathway. This anti-estrogen therapy is the cornerstone of treatment for about two-thirds of women with breast cancer, as their tumors over express estrogen or progesterone. While we have had great success with anti-estrogen treatment for estrogen receptor breast cancer, in some women cancer cells escape the signaling pathway and continue to grow.
CDK4/6 inhibitors are transforming late-stage treatment
Recently there have been some exciting developments in treating patients with an oral oncolytic called abemaciclib, a CDK inhibitor selective for CDK4/6. Rampant cell growth in many cancers is triggered by a loss of cell cycle regulation due to intensified signaling from CDK4/6. Abemaciclib obstructs the growth of cancer cells by specifically blocking cyclin-dependent kinases, CDK4/6.1 This induces cell cycle arrest, especially when combined with endocrine therapy.2 CDK4/6 inhibitors have revolutionized how we treat estrogen receptor positive stage 4 breast cancer, delaying the time to chemotherapy and increasing the amount of time patients can stay on anti-estrogen therapy when these drugs are added to the anti-estrogen regimen.
Since CDK4/6 inhibitors have been so effective in late-stage breast cancer, several clinical trials are now evaluating their use for patients with hormone positive, HER2– negative early breast cancer who are at high risk for reoccurrence. Two of the CDK4/6 trials are currently in progress across the US Oncology Network (The Network) for early stage patients; one investigating a drug called ribociclib and another studying abemaciclib. Both drugs were recently approved for late stage indications. I am hopeful that the benefits translate to high-risk early disease, giving patients a positive outlook early in their breast cancer journey. As a breast cancer specialist, I am very excited to offer these cutting-edge trials within The Network, giving patients convenient access to these novel therapies within their own community.
New options for HER2 positive cancer
Many promising trials are also occurring throughout The Network for early high-risk HER2 positive patients. Most women treated for HER2 positive disease do well with Herceptin along with chemotherapy. However, 10 to 15 percent of women still have a reoccurrence of the disease. We can now treat these women with a drug called pertuzumab. Some sites within The Network participated in an exciting clinical trial investigating the addition of pertuzumab to standard-of-care Herceptin in early, high-risk HER2 positive patients. The APHINITY Trial found that adding pertuzumab as a second HER2-targeted medicine modestly improved outcomes in node-positive women with HER2 disease.
Another drug, neratinib, has recently been approved for maintenance in women with HER2 disease who have been treated with Herceptin and chemotherapy, providing a new treatment option for patients who remain at significant risk after targeted therapy.
Progress for triple-negative patients
Triple negative disease remains an elusive form of breast cancer to treat in some women, as there is no known actionable target as in other breast cancers, but we’re beginning to see progress. Traditional therapy utilizes chemotherapy by itself, which can be very effective in many women. However, we are trying to improve on that approach by testing for genetic mutations. We know, for example, that a greater proportion of triple negative patients harbor germline mutations inherited from their parents, making it even more important for us as physicians to know the familial history of our patients.
To gain this insight, The Network has a comprehensive cancer risk assessment initiative — the Genetic Risk Evaluation and Testing program — that advances precision care by providing individualized genetic data that may lead to cancer prevention opportunities and better treatment options. For instance, if triple negative patients are BRCA1/2 positive, they may be eligible for a class of drugs called PARP inhibitors.
For women with triple negative breast cancer where traditional chemotherapy has failed, immunotherapy looks promising. There is also a new drug, IMMU-132, that is demonstrating positive results in early studies. We encourage eligible patients to participate in clinical trials, as they may experience significant benefits while also playing a pivotal role in advancing cancer care for tomorrow’s patients.
A bright future for many breast cancer patients through targeted care
This is a very exciting time in breast cancer care, as the depth of knowledge we have accumulated is providing a strong foundation for successful treatment. We know that incorporating a healthy lifestyle with traditional anti-estrogen therapy and chemotherapy is very important. In addition, we are perfecting the ability to match the right patients with the right drug(s) at the right time, delivering more personalized, targeted care. For patients with advanced disease, we have many molecularly targeted trials, providing promising new treatments that deliver on the hope of a better tomorrow for all breast cancer patients. I am proud of the work we are doing in The Network to advance cancer care for patients everywhere and look forward to continued progress in providing our patients with the best advanced treatment options available.
1. https://investor.lilly.com/releasedetail.cfm?ReleaseID=1022428
I’ve seen great advancements occur over the last several decades in diagnostic imaging and radiation therapy, and today they are vital components of cancer care. Roughly 60 percent of patients undergo radiation and, as technology advances, there may be even more uses for it in the future.
How radiation therapy is used
Radiation therapy is the primary treatment modality in many cancers. Head and neck cancers are a good example. Radiation alone without chemotherapy is highly effective in small and medium sized oropharyngeal and laryngeal carcinomas, preserving voice and swallowing function while treating the cancer.
Similarly, prostate cancer can be successfully treated with radiation. Patients with small cancers, as well as those who have locally advanced prostate cancer, have an increased risk of incontinence and impotence after a radical prostatectomy. By combining hormone therapy, external beam radiation, or internal beam radiation (brachytherapy), continence and erectile function can usually be maintained.
Preoperative therapy is another way to use radiation, and it is typically given with chemotherapy to shrink tumors so that surgery can be more effective. The best example of this is in gastrointestinal cancers when patients have large rectal malignancies. Surgery alone would require removal of the anus and a colostomy. With preoperative chemotherapy and radiation, the tumor can be removed but function is preserved.
Radiation can also play a vital role after surgery. For breast cancer, radiation is almost always used after a lumpectomy to treat potential microscopic extensions of the disease. It is also important for mastectomy patients. Originally, radiation was only recommended for those with four or more positive nodes. However, clinical trials have shown patients with one to three positive nodes may also benefit from it. In other malignancies, like gastrointestinal cancers, radiation is utilized after surgery and chemotherapy to sterilize nodes or extensions of cancer cells.
Lastly, radiation is highly effective for palliation to deal with large tumors obstructing bronchi, pushing on the spinal cord, or growing into bone or nerves, resulting in decreased function or pain.
New technologies are advancing cancer care
The US Oncology Network (The Network) is committed to improving patient outcomes and the patient experience by utilizing promising new technologies, especially highly conformal ones that shape radiation to closely fit the cancerous area while sparing healthy tissue.
The two conformal treatments that are most effective for many cancers are Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT). In IMRT, the radiation beam is broken down into hundreds of beamlets of varying strength that, when added together, deliver high radiation to the targeted area, while minimizing exposure to healthy tissue. An illustrative example of IMRT is prostate cancer, where the tumor is wrapped around the rectum, and conventional treatment would impact upon the anterior rectal wall.
In IGRT, an imaging source similar to a CT scanner is connected to the linear accelerator, providing cross sectional images of the tumor. This enables the clinician to very precisely position the patient on the treatment table, ensuring accuracy.
A third technology The Network is focusing on is Stereotactic Body Radiation Therapy (SBRT), a technique that delivers high doses of radiation in very few treatment sessions. Because of the dose strength, clinicians must be absolutely certain they are precisely targeting the tumor, as exposed tissue adjacent to the tumor might be injured by the very high doses of radiation.
The Network is investing substantial time and resources to ensure practices have the appropriate equipment to administer SBRT and that our physicians, physicists, dosimetrists and therapists are properly trained. SBRT is now available in every region across The Network, and our goal is to bring the technology to every radiotherapy center in the organization.
A technology experiencing increased utilization is brachytherapy, a treatment that surgically implants sources containing radioactive material directly into the tumor. Advances over the last decade have made it safer for the clinician to administer this treatment.
Exciting new technologies are under development that will greatly advance cancer care. Magnetic Resonance Imaging (MRI) and PET scanning are both being combined with radiation delivery technologies, enabling better assessment of localization and treatment effectiveness.
Because technologies are changing rapidly, The Network is committed to bringing innovative treatments to patients as soon as they become available.
Technology is not the whole story
Advanced technologies are necessary for successful treatment, but by themselves are insufficient to achieve optimal outcomes. A sharp scalpel is useless unless the person holding it is both well-trained and kind. Radiation oncologists in The Network are continually assessing and improving their quality and expertise. The entire care team must also demonstrate empathy and caring for the patient. One of the wonderful things about being a radiation oncologist today during a time of great technological advancement is the ability to marry care and concern for the patient to advanced technology. I am extremely proud that practices in The US Oncology Network are focused on merging high tech with high touch providing patients and their families the best possible cancer experience.
Public awareness of hereditary cancer syndromes has come to the forefront over the last several years, due in part to celebrity disclosures. Community-based oncology practices play an increasingly important role in identifying patients and families who are at hereditary risk for cancer.
Preventing cancer, not just treating it
Genetic testing is an important part of comprehensive cancer care. Testing is an opportunity to provide cancer prevention strategies to patients with a hereditary risk of cancer. A defined genetic risk evaluation program enables practices to do more than just treat the disease. For many people that carry mutations, there are both preventative and patient management consensus guidelines for their care. Likewise, some patients whose testing does not reveal a hereditary mutation may still require a management plan based upon their family history.
An established genetic testing program has the potential of not only helping the patient, but also at risk family members. A hereditary risk assessment with a three generation pedigree can identify potential risk within a family even if there have been uninformative genetic results.
The Genetic Risk Evaluation and Testing program
According to the National Cancer Institute, inherited genetic mutations are linked to approximately 5 to 10 percent of all cancers, and more than 50 hereditary cancer syndromes have been associated with mutations in specific genes.1 Recognizing this high-risk population was underserved, in 2007 a group of physicians in The US Oncology Network (The Network) with advanced genetic expertise collaborated to develop a formalized genetic program, The Genetic Risk Evaluation and Testing (GREAT) program.
The GREAT program provides a framework for practices to successfully implement genetic evaluation and testing based on best practices. The framework provided by GREAT helps a practice plan and implement critical aspects of a genetics risk evaluation program, such as identifying who should conduct genetic counseling, how practices should bill to ensure reimbursement, identifying which panel tests to use for which patients, and guidance on how to build a robust genetics database.
Program experts work with practices to develop a customized approach to deliver the following components to patients:
- An initial consultation by trained staff to gather family history, educate the patient and evaluate risk.
- Genetic testing after a thorough risk assessment using a variety of techniques.
- A follow-up consultation to discuss findings, educate the patient and address personal concerns.
- A proactive, individualized care plan for patients who test positive for genetic mutations. Options may include chemoprevention, surveillance or preventative surgery. The impact on family members is also discussed.
Contributing to genetics research
Through the GREAT program, The Network is playing a significant role in genetics research. With extended next generation sequencing, we have seen a significant rise in Variations of Uncertain Significance (VUS) – a variant form of a gene in which we do not know its significance to the health of the patient. VUS detection and reporting by genetics companies can be unsettling to patients and they have the potential to be misunderstood by providers. A VUS is a variation that is reported but, by current knowledge, should not lead to surgical or medical intervention. The Network is collecting data on VUSs and doing long-term follow up with patients to help determine their significance, advancing the knowledge-base within the oncology community.
Practices also benefit
Genetic testing offers benefits to practices, as well as patients. Since treatments are now available for some cancers linked to specific mutations, genetic testing enables practices to deliver personalized cancer care that helps patients achieve optimal outcomes. Practices with genetic testing programs are leaders in cancer care and comprehensive genetic services are a valuable resource for the entire medical community, including referring physicians. Additionally, people who test positive for mutations will likely rely on the practice that identified their mutation if they do need cancer care.
Build a world-class program with GREAT
All practices in The Network can efficiently implement genetic counseling and testing with the GREAT program. Practices considering offering these services may be worried about costs and managing various aspects of the program, but they can rely on the experience, extensive knowledge-base and innovative resources of The Network to provide a strong foundation to help ensure success. The Network offers a variety of implementation models for the GREAT program, including those utilizing physicians, Advanced Practice Providers or genetic counselors in the counseling role. The Network works closely with practices to customize an operational model to meet their needs.
John Sandbach, M.D. GREAT program co-founder
Medical Oncologist/Hematologist, Texas Oncology
1. https://www.cancer.gov/about-cancer/causes-prevention/genetics
July 1 marks the one year anniversary of the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model (OCM), a bold new program focused on providing higher quality, more coordinated cancer care for Medicare beneficiaries with attention on managing costs. The program provides upfront payments to fund practice transformation with the expectation that practices will use these funds to provide enhanced services to patients, submit quality metrics and learn from data sharing.
The OCM is a very large, complicated program that calls for a new way of delivering care for the 190 practices who are participating, including 14 in The US Oncology Network (The Network). Some are adjusting well to program requirements, while others struggle to keep up with the multiple rule changes and frequent updates. We have received feedback from participating practices in The Network that the efforts by McKesson Specialty Health have been instrumental in driving practice transformation. They have learned quickly that it would be very difficult to succeed in this government program on their own.
While we will not know how well our practices in The Network are performing in the program until Medicare delivers their first reconciliation reports six months from now, practices have been taking the OCM very seriously and are striving for high performance.
Early Successes
Even though we do not have final data yet from Medicare, some early successes have been identified across The Network:
- A better patient experience
For example, most of our practices have adopted team huddles as a way to identify and help at-risk patients. The huddles have been very successful in helping patients who have needs that might otherwise go unmet.
- Improved care coordination
Practices are more proactive in coordinating care with other entities in the health care environment, such as hospice, urgent care centers, social workers, and other providers.
- Advance care planning for more patients
Advance care planning, an important component of the OCM, is a critical part of quality care often overlooked. Many patients fall through the cracks when it comes to documenting their values and wishes. Good advance care planning helps ensure they receive the care they want during their entire course of treatment.
Major Challenges
While we have identified early successes with the program, we have also encountered some obstacles and a steep learning curve:
- Practice transformation is not easy
Practices have a certain way of doing things, and it is challenging to justify major changes in the clinical work flow. For example, why is there even more clicking (documenting) in the EMR? Do the quality metrics really improve quality of care? Are program demands simply creating more work?
- Identifying patients who should be in the program, particularly those receiving oral drugs only
It is often hard to know which patients meet criteria for enrollment, particularly those on oral medication. Intravenous medications are administered within the walls of the clinic so it is easier to identify and enroll these patients in the OCM. Patients getting oral drugs often have to receive their medications from an outside pharmacy and this is difficult to track. To date, we do not have a good solution to capture patients prescribed oral drugs only. This a problem common to all practices in the program, not just those in The Network.
- Submission of data is challenging
McKesson Specialty Health and The US Oncology Network have developed great tools to help our practices submit their EMR data, but it still requires a lot of work. For practices outside The Network, this is probably their biggest challenge.
- There is uncertainty concerning hiring new staff
CMMI provides $160 per-beneficiary monthly for the delivery of enhanced services, which, in turn, means practices are expected to hire new staff to deliver these enhanced services. Practices are still trying to figure out what type of hires to make, how many people to hire, and how best to optimize performance in these new positions.
Will the OCM Survive?
The OCM, a five-year project, will most likely last for the entire period, but the future beyond the OCM is still uncertain. Practice transformation takes time, so it will be several years before we even know if the model works. If this particular model demonstrates cost savings, something similar could serve as a more permanent method of reimbursement for cancer care. Future models are expected to move even further towards shifting risk to the practices and rewarding those who can manage risk. Whatever happens over the next few years, there will not be a return to full fee-for-service.
A Bridge to the Future
It’s unlikely the elements of the OCM will represent the ultimate method of reimbursement. Rather, it is more likely a stepping stone to future reimbursement models. So, at the least, the OCM is good “practice” to begin learning how to build an infrastructure that drives value and manages risk. McKesson Specialty Health and The US Oncology Network are supporting our practices by working closely with them as they transition to this new way of doing business. Holding boot camps, providing subject matter expertise, and developing innovative resources are a few of the ways we are helping them master this challenging new environment.
While implementing the OCM is difficult, it is important to realize the model is genuinely good for patient care. Patient feedback has been very positive, as patients recognize and appreciate the extra attention they are receiving within this model. It remains to be seen if the 190 practices can take on all the additional requirements, perform well, and be rewarded for doing so. If so, patients and practices will come out ahead.
Marcus Neubauer, MD
VP and Medical Director, Payer and Clinical Services
McKesson Specialty Health and The US Oncology Network
Many physicians and clinicians across The US Oncology Network (“The Network”) have just returned from the American Society of Clinical Oncology’s (ASCO) Annual Meeting. As one of the largest cancer meetings in the world, this event brings together more than 35,000 oncology professionals from around the globe. This year’s conference was very energizing, highlighting many promising new therapies and care strategies, while enabling networking opportunities with some of the brightest minds in oncology research and cancer care.
The conference also enables us to meet with our pharma partners. We had several meetings with manufacturers about drugs in their development pipeline, with discussions focusing on how we might accelerate the completion of their trials to speed FDA approval or approval for new indications. Additionally, we identified about 40 new clinical trials we might participate in with our pharma partners in the upcoming year.
The actual meeting itself also helps us provide better care, as attendees have access to thousands of presentations about the most important developments occurring in oncology worldwide.
The Network had a strong presence
The Network made a very strong showing at ASCO through our research organization, US Oncology Research. We had several key presentations involving novel drugs or novel drug combinations in various hematologic malignancies, including non-Hodgkin’s lymphoma and chronic lymphocytic leukemia. We were also part of a team studying a promising new PDL-1 inhibitor, pembrolizumab, for triple negative breast cancer, an aggressive subtype of the disease. Our Phase I program had a large number of posters looking at novel agents in a variety of different malignancies. All in all, we had about 40 presentations including oral, poster and published abstracts at the meeting, demonstrating that The Network is at the forefront of clinical research.
Key takeaways from the conference
One of the most promising advances revealed at ASCO was CAR-T cell therapy, which involves engineering a patient’s own immune cells to treat their cancers. It will likely receive FDA approval for certain types of acute leukemia and recurrent non-Hodgkin’s lymphoma, and studies are now being launched in myeloma, chronic leukemias and solid tumors. The Network has one site participating in those trials, and we have created a task force to evaluate the opportunities and barriers to bringing CAR-T cells to a broader swath of The Network in 2018.
Immuno-oncology trials also generated a huge amount of interest, as they have at past conferences. These studies examine drugs called checkpoint inhibitors that target and amplify the body’s immune system to help fight cancer. The growing list of trials involving checkpoint inhibitors, either by themselves or combined with chemotherapy or other molecularly targeted drugs, was a very prevalent theme at the meeting. The Network has conducted over 60 trials looking at PD-1 or PDL-1 binding antibodies either alone or in combination with other therapies just in the last 3 years.
There was also considerable discussion around the challenges of providing expensive, leading-edge therapies to patients while attempting to control costs in an era of value-based care. Several presentations were given where the addition of a new drug provided somewhat modest benefit to some patients, but with an additional price tag of $100,000 a year. How to advocate for our individual patients while being stewards of our countries limited resources is becoming a more central issue in the evolving landscape of value-based care.
One final takeaway from the conference is that the pipeline of new cancer drugs has never been richer. An enormous number of trials are currently underway. In fact, over the last few years, the discussion has shifted from physicians wanting more good trials to concerns that there are not enough patients participating in trials to complete all the promising studies available. Recruiting patients for clinical trials remains difficult, as less than 5 percent of cancer patients join a trial. An interesting presentation at ASCO focused on the barriers to trial participation. Foremost among them was the misconception that cancer trials include placebos. Other factors were patient concerns about additional costs if they participated in a trial, as well as a perception that trials were not available close to home. US Oncology Research provides a solution to the later issue and the presentations at ASCO, the rich drug pipeline, and our robust participation in clinical research reminds me that we have much to contribute as a network as we look to prevail over cancer.
The future looks very bright
The progress in cancer care over the past several decades is breathtaking, and the future looks even more promising. The advances in targeted therapy and immuno-oncology, as well as the new approach to treating patients more holistically, hold vast potential to help cancer patients live longer and better. Cancer mortality is dropping, and just in the past few years, the period of time people are living with advanced cancers has increased for many of the most challenging malignancies. I am very optimistic that the outlook for cancer patients will continue to improve, with great strides being made in the not too distant future.
Michael V. Seiden, M.D., Ph.D.
Senior Vice President and Chief Medical Officer
McKesson Specialty Health and The US Oncology Network
May is Oncology Nursing Month, a time set aside to honor our special medical professionals who have dedicated their careers to serving cancer patients. There are many different types of oncology nurses throughout The US Oncology Network (“The Network”), including those who work in infusion, radiation, surgery, gynecology, research and management, as well as nurse navigators and patient educators.
Oncology nurses make a difference in patients’ lives every day by being their advocate and educator, guiding them through treatment, celebrating their victories, and providing comfort in times of need―all while ensuring the patient receives the best care possible. The US Oncology Network thanks all of our compassionate, highly-skilled professionals who not only provide exemplary physical care, but also offer psychosocial support to patients and their families throughout the care continuum.
Focus on Nurse Navigation
With many practices in The Network participating in a variety of value-based programs, we have seen significant growth in nurse navigator positions, an area of oncology nursing that focuses on care coordination. The nurse navigation concept is not new, as navigation was first introduced in 1990. Over the years, much effort has gone into defining and delineating the responsibilities of this role. A primary responsibility is to ensure the treatment plan for each patient is fully implemented by all members of the care team. Navigators typically organize “patient care conferences” or “huddles” when the patient’s treatment plan and any unmet patient needs, both physical and psychosocial, are reviewed by the multidisciplinary team. Additional services for the patient, such as a referral for social services, financial counseling, advance care planning or procedures at an outside facility may be identified during this discussion. Smooth transition of care from one provider to another is a key milestone of value-based care. Nurse navigators manage the day to day operations to make that possible, assuring handoffs are smooth and seamless, ensuring the best patient experience.
Nurse navigators play a key role in patient advocacy and engagement, both of which drive and support patient empowerment and shared decision-making. Nurse navigators, as well as other types of nurses, engage patients through education that empowers them to ask informed questions, request the care they desire, and self-manage symptoms when possible.
The Oncology Care Model, along with other value-based programs, is bringing the role of the nurse navigator to the forefront. There is growing recognition that the critical activities outlined in these various programs must be addressed and that providers must do a better job of offering these vital services to patients. Nurse navigators―highly skilled professionals who blend and balance expertise with compassion―are an effective solution.
During Oncology Nursing Month, we once again want to recognize and thank our oncology nurses, as well as the dedicated clinical staff members that assist and support them in providing compassionate quality care. For those nurses not interested in navigation, The US Oncology Network offers many other rewarding oncology nursing opportunities. The Network is committed to supporting the growth and professional development of all our nurses and clinical staff who strive tirelessly every day to help us reach our goal of providing the highest quality patient care in a community setting.
Beatrice Mautner, RN, MSN, OCN®
Sr. Director, Care Delivery
The US Oncology Network
There is no denying this is a difficult time to be an oncologist. We are in unknown territory with the current political and economic climate. Fortunately, those of us in The US Oncology Network (“The Network”) are not facing today’s challenging environment alone. We have the expertise and resources of The Network behind us, including the collective knowledge and strength of our 1,400 member physicians.
On April 6-7, The Network, which is a physician-led organization, gathered once again for our annual conference. This is our biggest event of the year– a time when our leaders, physicians, clinicians and pharmacists come together to discuss new developments in The Network and critical issues that have an impact on oncology community.
As in past years, the conference was held in conjunction with our P&T physician leadership committees and executive director meetings. A special workshop for new physicians was also held during the conference. New physicians bring fresh ideas and energy to our organization, and we consider their success of the upmost importance. Bringing together such a wide variety of high-achieving, knowledgeable oncology professionals provides a unique opportunity to network, collaborate and exchange ideas, empowering all of us to succeed while advancing cancer care.
The theme of our conference this year was “In This Together.” It reflects the passion we have to find the synergies within the many facets of the healthcare ecosystem―uniting independent physicians with payers and manufacturers, enabling and supporting end-to-end efficiency and clinical excellence across the spectrum of cancer care. Together, we are a strong force that can drive solutions to meet emerging challenges, ensuring patients will always have the opportunity to choose quality care in a community setting close to home. Physicians, payers and manufacturers are realizing that by working together, we can succeed together in this ever-changing environment.
During the general session, attendees learned what it means to be “In This Together” from the patient and payer perspective, as our two keynote speakers presented their unique views on the topic:
- Adrienne Boissy, M.D., M.A., Chief Experience Officer and staff neurologist at the Cleveland Clinic, spoke on transforming the patient experience and asked “do innovations bring us closer to patients or further away?”. Dr. Boissy’s team created a comprehensive program to strengthen provider communication skills and has trained thousands of staff physicians and clinicians.
- Jennifer Malin, M.D., Ph.D., Senior Medical Director, Oncology and Genetics, UnitedHealthcare, gave attendees a view of oncology care from the payer perspective. Dr. Malin is widely recognized for her research on the quality of cancer care and is the architect of various cancer care quality programs in use across the insurance industry.
Additionally, we heard from John Goodman, the keynote speaker for our biannual P&T meeting.
- John Goodman, Ph.D., founder of the Goodman Institute for Public Policy Research, shared his view of likely policy and access changes that are in store for us in the new administration. Widely recognized as an expert in economic policy, Modern Healthcare named Dr. Goodman one of four people in the nation who have most influenced the changes shaping our healthcare system.
Our Senior Vice President and Chief Medical Officer for The Network, Michael Seiden, M.D., Ph.D., also presented on the importance of Research in The Network as well as his perspective on what it means to be “In This Together.”
Attendees heard from our key leaders who gave us a look at the past, present and future of The Network. Heather Morel, our Chief Operating Officer, brought us up to date on many of the exciting new initiatives occurring across The Network and those that are in the works, while Kirk Kaminsky, President of The Network, reviewed our accomplishments from the past year, which were substantial.
In addition to the general session, attendees also had more intimate learning opportunities during our breakout and poster sessions that spotlighted more than a dozen best practices from around The Network. A wide range of subjects were covered, such as palliative care, proton therapy, MIPS, value-based care contracts, and data-driven patient referrals, to name only a few of the many sessions available.
I think we all came away from the conference energized and with a much better understanding of how critical it is for all stakeholders in the cancer community to work together towards realizing our strengths, finding synergy, and providing true Network-wide support for the delivery of cancer care locally. Looking beyond our own ‘filter bubbles,’ we can find novel solutions and reconfirm the common ground that unites us.
Lucy Langer, M.D.
Practice President, Compass Oncology
Chair, National Policy Board and National Policy Board Executive Committee
The US Oncology Network
You’ve probably heard the saying, “If you’re standing still, you’re moving backwards.” This certainly is true for healthcare providers today, especially community oncologists. Complex healthcare regulations, declining reimbursements, rising overhead and increasing demands for quality reporting are changing the face of the oncology practice.
For a community oncology practice to remain viable and successful in this challenging environment, it must not only respond to the rapid changes in the healthcare landscape, it must stay ahead of the curve. While we don’t have a crystal ball to see what’s coming next in cancer care, The US Oncology Network (“The Network”), a physician-led organization, does have the collective expertise and knowledge of over 1,400 member physicians to help us define and anticipate future trends.
We recognize that as the environment changes around us, we, too, must change. To that end, The Network, supported by McKesson Specialty Health, has been busy over the past few years aligning our service and solution offerings with the changing needs of the market. This is an ongoing process. We are constantly looking around the corner and adapting our portfolio of business support services, value-based care tools and enabling technologies to meet the evolving needs of our physicians so they can stay on the leading edge of healthcare trends. This continual self-analysis ensures we are providing our community-based allies all of the resources, infrastructure and expertise required to thrive in the demanding value-based environment of today as well as the future.
As part of our rebranding endeavor, we have completely redesigned our website into a dynamic new format that mirrors our mission to help community practices remain strong and vibrant through innovative solutions that support high quality value-based care. The new website is part of our effort to enhance the quality and availability of information about The Network for physicians and patients. In an increasingly virtual age, it will play a vital role in our ongoing efforts to convey the value of The Network.
The site’s bold, uncluttered design, streamlined menus and simple navigation deliver an engaging, user-friendly experience, providing more information from a quick read while allowing users to dive deeper for more details with a single click. Not only does the website provide valuable information for patients and present the many benefits physicians gain by joining The Network, it also showcases many of our dedicated physicians and staff discussing how The Network helps them provide quality care. You can also find patient stories that show the dedication and high-quality care they received from practices in The Network. I invite you to check out their stories to get a better understanding of what The Network can do for physicians and patients.
We are very excited and proud to launch our new website, and we hope you enjoy exploring all that it has to offer. As you do, I think you’ll feel the passion and dedication of everyone who was involved in shaping this new public face of The Network.
Kirk Kaminsky
President
The US Oncology Network and Practice Management
McKesson Specialty Health
