Community oncology has transformed itself substantially over the last 30 years, adapting to clinical and financial changes and participating in ongoing innovative pilot programs.
In my role at AmerisourceBergen, I’ve seen first-hand the improvements to access and patient care that community practices have helped realize. But now, perhaps more than ever, is a pivotal time for community oncologists to build upon their standing as essential providers of accessible, affordable, quality care.
I recently spoke at ION Solutions’ Large Practice Program (LPP) National Meeting in Washington, D.C., where more than 500 of the nation’s leading community oncology professionals gathered to evaluate challenges and forge the path forward for the field. Echoed throughout the meeting were similar sentiments: the same trends threatening practice viability are opening new doors for community oncologists to streamline care, enhance reporting, and improve patient outcomes while lowering costs. As health system consolidation remains a top concern for many community clinicians, they recognize the need to evolve with the industry and, in many cases, ahead of the industry.
There is a level of personal care that is a hallmark of community oncologists. In the era of value-based medicine, this has become more important than ever. To achieve the reimbursement benefits presented in this new model, practices have to master data collection and reporting. For the last several months we’ve been getting feedback on the Oncology Care Model (OCM)—a CMS payer model focused on prioritizing higher-quality coordinated oncology care—where 160 community oncology practices participated. With this feedback and data, practices can better understand costs and how to potentially bring them down. We’ve applied a “Smart GPO” approach to equip participating practices with the analytics capabilities they don’t have in-house to make sense of what we’re hearing and tailor their operations accordingly.
For example, in some instances, we can now leverage the business intelligence pulled from practice-specific data, like prescribing patterns and patient history, to better establish the terms of Group Purchasing Organization (GPO) contracts for certain therapies. These insights allow oncologists to improve the quality of care and create performance metrics, which inform clinical decision-making, cost management and revenue management—all crucial to the overall health of a practice in a value-based care environment.
These insights can also play a role in how GPO contracts are structured with manufacturers. If health insurers pay drug manufacturers based on the efficiency of a product rather than on usage alone, then there is an opportunity for community physicians to support a better reimbursement model based on the outcomes they deliver. With the right understanding of the data from OCM, community oncologists can advocate for reimbursement approaches that prioritizes higher quality cancer treatment over higher volume alone and puts pressure on other stakeholders, including manufacturers and health insurance companies, to prioritize high-quality cancer care in the community.
Another way community oncologists can enhance their care while generating meaningful data in light of value-based care is by becoming more medically-integrated. Oncologists that manage both the patient treatment process and medication dispensing have a clearer picture of a patient’s progress and can track it over longer periods of time. The access to patient EMRs and familiarity with each patient’s unique case means they can work closely with an in-office pharmacist to ensure patients receive their medication in a timely manner and remain adherent, as well as address adverse events. All of which leads to the elimination of unneeded hospitalizations, a healthier patient and improved outcomes to report.
Driven, in part, by the shift in care delivery from community-based practices to 340B hospital settings, annual cancer care costs are estimated to surpass $158 billion by the year 2020, according to Journal of the National Cancer Institute research published in a recent whitepaper published by strategic consulting firm, Xcenda. Community oncologists must act now to position their practices against this trend and remain relevant for tomorrow’s healthcare environment. Cancer patients are always going to need local care that is cost effective and hands-on. By using resources provided by the “Smart GPO” to navigate OCM, oncologists stay informed on how they can maintain financial viability to continue to bring affordable care to patients. This will ultimately lower healthcare costs on both a patient and government level while improving public healthcare overall.
Barry Fortner, PhD, is president, Specialty Physician Services at AmerisourceBergen.