The 5 Biggest Challenges for Stakeholders in the Oncology Value Chain

Interview with Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy, a speaker at IIR's upcoming Annual Summit for Oncology Management, July 21-23, in Philadelphia.

 

What are the 5 biggest challenges for stakeholders in the Oncology Value Chain? And why?

Despite tremendous advancements, there remain significant challenges in the Oncology Value Chain.

First, there remains a lack of meaningful integration of the stakeholders.

The silos that exist in this area of healthcare limit communication and, ultimately, patient health outcomes, whether by virtue of geography, subspecialization, organizational structure or fragmented data. 

One area this is evident in is the duplication of existing services capabilities by hospital networks. For example, primary care network management, pharmacy services, hospice, and other services lines are often redundant with those already existent in the provider community. “Big data” capabilities remain in repositories that are not driving insights to improve healthcare across provider segments.  Informatics pointed toward patients communicate/replicate medical terminology without flags, links or explanations comprehensible by the most highly educated laypeople.

Pharmaceutical manufacturers with patient assistance and nursing support programs, interactions with PBMs and Plans regarding formulary management, and aligned economic incentives are hampered by the “silo” approach when they tailoreprograms and pricing to differeing classes of trade, sometimes to their detriment.  As an example, a manufacturer of a new oral medication treating a disease previously less well treated by infused therapies experiences 75% dose titration in its clinical trial. To roll the drug out, it conducts Physician Advisory Boards, Physician Clinical Education and Healthcare Economic Outcomes Reviews of Prescribing Patterns.  As the drug is an oral therapy and most likely dispensed by a pharmacy, the manufacturer also established an 8 pharmacy Limited Distribution Network for the drug.  However, no program was instituted for the pharmacies and the prescribing physicians to share information and ask questions regarding dose titration.  Real world dose titration was 27%, thereby resulting in lower uptake of the drug and less benefit for patients.

Once data becomes ubiquitous and the tools to access and comment on the data are available through a user-friendly system, we will move to risk-sharing model that would benefit all stakeholders.

Second, there remains a lack of novel approaches to therapy management that improve patient empowerment. 

Value-based care has historically worked well with diabetic & cardiovascular patients.  Pitney Bowes and Safeway both have successfully implemented programs to align the interests and needs of employers and employees.  Similar practices could be further leveraged within the oncology treatment process.

Shoppers Drug Mart created a pharmacy benefit plan based upon a retail pharmacy services model wherein enrollees could qualify for a progressively enhanced series of incentives, benefits & rewards if they (i) completed an Health Sstatus Assessment, (ii) elected to participate in health management programs for one of 5 high cost diseases which they evidenced experiencing, (iii) progressed through milestones associated with disease-specific therapy management and (iv) sustained their health gains over a period of time.

Cardinal Health and P4 Pathways, as well as Wellpoint Aim, established Pathways Programs in Oncology wherein NCCN guideline-based Formulary, Interventions and Outcomes metrics drove Best Practices and savings at a rate of 5 to 15 percent, depending upon the flexibility of the pathway, the pre-existing Clinical Best Practices approach, etc.  Using a series of interventions, the program managed and documented cadence and content, exchanged generics for brands where appropriate, managed dosing, reduced combination therapy in later stages of therapy and provided regular clinical checks for patients.  These novel programs could gain more widespread utilization within the industry, provided collaboration occurs real time amongst physicians, pharmacists and disease therapy management providers.

Third, there is not a clear intersection / integration for providers, payors, patients and pharmaceutical manufacturers on healthcare coverage issues. 

There needs to be a shift from “Class of Trade” thinking to “Patient Engagement” thinking by the stakeholders.  There should be a standard of care, regardless of class of trade.  The appropriate treating provider based on clinical expertise, patient location and unique patient healthcare and socio-economic needs would have the data accessible to delivera consistently measured and reported standard of care.

Fourth, the cost of oncology therapy and care management continues to rise dramatically.
 
Currently, care management spending is $100B annually and is projected to be $200B by 2020.  This is compounded with the cost of specialty medications that, at $100B, represent 25% of pharmacy spend today.  By 2015, this is projected to reach over $180B and could trend over $400B by 2020.  A large driver of this cost is hepatitis-C treatment, but oncology is also making tremendous impact.
While  costs may be fueling  tremendous medication advancements, more focus needs to be place on the HEOR (health economics outcomes research) to better understand the end-to-end measurement of costs and health outcomes.  With greater transparency of data to measure results of therapy, we could better align incentives and savings and service models. 

Fifth, across all stakeholders, there needs to be an improved knowledge of the oncology value chain.

We are seeing gains in this challenge.  An example is the (recent) traction of the oral parity laws that ensure equal coverage for infused oncology therapies versus oral oncology therapies.  In a study done by Prime Therapeutics, it was found that one in six cancer patients with high out-of-pocket costs abandon their medication.  The same study found that patients with an out-of pocket cost greater than $200 were at least 3 times more likely to not refill prescriptions than those with OOP costs of $100 or less.  The technology has evolved, but because of cost differentials, patients may not reap the rewards of these advancements.

Improved knowledge would benefit the oncology community in the areas of drug safety, specifically pharmaco-vigilence programs and than transparency of reporting to provider and pharmacies.

How do specialty pharmacies like Avella assist with these issues?   

Specialty pharmacies are in a unique position to connect the stakeholders in the Oncology Value Chain.  Leveraging their position of having meaningful interactions with the many oncology stakeholders (patients, payors, manufacturers, healthcare providers), specialty pharmacies should serve as a “hub” for the stakeholders.  Formulary management, step therapy implementation, HIPAA-protected real time data collection and reporting, access to performance of patients across providers, payers and therapies – all these in one tool-based repository are available through Avella and its clinical pharmacy team.

With a deeper connection between the stakeholders, the data each group is collecting and measuring becomes more transparent and useful.  Harnessing the data, specialty pharmacies can become a leader in health economics outcomes research and ultimately find additional cost savings solutions.

Finally, through increasingly meaningful patient engagement, specialtypharmacies can improve communication, adherence levels, patient literacy levels, and clinical outcomes.  This short video highlights several of the ways Avella and specialties pharmacies benefit patients:  https://avella.wistia.com/medias/fksa6j9ntg


About Rebecca M. Shanahan:

As Chief Executive Officer of Avella Specialty Pharmacy, Ms. Shanahan brings extensive healthcare and specialty pharmacy experience to Avella Specialty Pharmacy. Ms. Shanahan served as Executive Vice President and Head of the Aetna Specialty Pharmacy from 2005 - 2007 and as a member of Avella Specialty Pharmacy’s board of directors from 2010 – 2013.

Prior to joining Avella Specialty Pharmacy, Ms. Shanahan was president of Shanahan Capital Ventures, LLC, (SVC) a consulting firm that built strategic business initiatives and programs for a number of healthcare entities in the United States and Canada. SVC clients included Cardinal Healthcare Specialty Solutions, Shoppers Drug Mart, Rite Aid Pharmacy, US BioServices, Bayer Pharmaceuticals, Bristol-Myers Squibb, Inspirational Biologics, MedSolutions, and Reliant Rehabilitation.

To learn more about Rebecca and the other members of Avella leadership, please visit www.avella.com/leadership. 

Rebecca will be a speaker at the upcoming Oncology Management Summit held July 21-23, 2014 in Philadelphia. Register now and save 15% when you use the code: XP1914BLOG.

ASCO to Help Cancer Docs Evaluate Treatment Value

Below is an article from Modern Healthcare - a media partner for the upcoming Summit for Oncology Management. To learn more join us July 21-23 in Philadelphia, register now and save 15% when you use the code: XP1914BLOG - or sign up for email updates.

Via Modern Healthcare: The American Society of Clinical Oncology's algorithm to help oncologists evaluate the clinical benefits, side effects and costs of a cancer drug or therapy will be fine-tuned over the summer and should be available for public comment by the fall, said Dr. Lowell Schnipper, chair of the society's Value in Cancer Care Task Force.

That was just a small portion of a much larger discussion at ASCO's annual meeting about what needs to be done in order to get soaring cancer care costs under control. Assessing the value of cancer therapies was a major topic, with sessions looking at issues like whether or not patients are getting what they pay for, the ethical obligations faced by physicians and what if anything can be done to help drive down the costs. Although there have been important advances in cancer therapies over the past few decades, drugmakers are more frequently creating generic versions of previous innovations which often sell at higher prices.

The ASCO task force started meeting with consultants and other value experts earlier this year to begin developing the cost-comparison tool, in response to growing concerns over the rise in new, more expensive cancer drugs that provide only incremental benefits for patients.

“We want innovation,” Schnipper said, “But at the same time, we don't want our patients and their families to go bankrupt for a treatment that only offers a few additional months of life.”

Annual global spending on cancer drugs is approaching $100 billion, and the average cost per month for a brand-name oncology drug is approximately $10,000, nearly double from what it was a decade ago, according to recent estimates from the IMS Institute for Healthcare Informatics.

According to an analysis in the journal Mayo Clinic Proceedings:
• One melanoma treatment costs upward of $120,000
• Three doses of a prostate cancer medication have an estimated $90,000 price tag and
• A lifelong treatment for chronic myeloid leukemia averages around $70,000

Experts say more needs to be done - by physicians, pharmaceutical companies and government - government - to fix what one economist called “the perverted prices” of cancer drugs.

At this year’s conference, Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, said “We have an obligation to improve the system, there’s no way the current one is going to sustain the costs”. He predicted that the rise in costs and the projected impact on U.S. health spending will get the attention of policymakers.

Rena Conti, assistant professor of health policy and economics at the University of Chicago, presented new research during a session at the conference. She determined, the largest predictor of a new drug’s price is how a similar drug was priced the previous year. “Benefit matters,” She said, “But we’re seeing launch price inflation, even in relatively crowded therapeutic classes.”

Conti suggests that adjustment to physician payment policies would help this situation. “Physicians have a financial incentive to use really high-cost cancer drugs even when the potential benefit for the patient may not be much more,” she said. Their revenue is based on the difference between the price they pay for a drug and how much insurers will reimburse them.

Hospitals also face perverse incentives. Schnipper said hospitals get paid for how many patients they admit, procedures they do and how much chemotherapy they give. “That is not a prescription for cost control,” he said. “We all know that something has to change.”

Read the complete article on Modern Healthcare now.

Hear from CMO of BCBSA on Rising Cancer Care Costs

 America's National Institute of Health predicts that spending on all cancer treatment assuming a 5 percent annual increase in these costs raises the projection to $207 billion.

Due to an aging population, increased cancer diagnosis, rising cancer care expenses, and a demanding payer market, new strategies need to be addressed for pharmaceutical companies to maintain, commercialize, and increase oncology access in the marketplace. It is imperative to learn from experts who are able to deliver affordable cancer care, while improving quality and bend the cost curve downward

At IIR’s Annual Summit for Oncology Management taking place July 21-23 in Philadelphia, you will hear from Dr. Trent Haywood, MD, JD SVP Office of Clinical Affairs and Chief Medical Officer at BlueCross BlueShield Association, a trend-setter in this space. Dr. Haywood will be discussing the so-called “cancer conundrums”, focusing on the current issues and challenges your industry is facing and shed light on some of the successful strategies that have worked for BCBSA.

Download the brochure to view Dr. Haywood’s sessions and more.

Register now to meet and collaborate with all the key stakeholders across the oncology management landscape including BCBSA, Aetna, Astellas Pharma, Eli Lilly and more! Save $200 by Friday, 6/20. Please use your code XP1914BLOG

Dr. Trent Haywood, MD 
 As the BCBSAs’ chief medical officer, Dr. Haywood supports the innovation of Blue Cross and Blue Shield companies in communities around the country as they improve the choices of healthcare quality and patient safety for their members. He is responsible for the Office of Clinical Affairs, which includes the Center for Clinical Effectiveness, Center for Clinical Practices, and the Center for Clinical Value. Collectively, the Office of Clinical Affairs supports opportunities between Blue Cross and Blue Shield companies and stakeholders to improve the choices of affordable, high quality healthcare provided to members.

Clinical Pathways, ACOs, COAs: Introducing 'Value' in Cancer Care

Below is an article from AJMC - a media partner for the upcoming Summit for Oncology Management. To learn more on topics like this, sign up for email updates. 

Via AJMC: Although advancements in medical science have greatly improved overall life expectancy and the ability for many to survive a cancer diagnosis, a recent study predicts that cancer care alone will cost the American health system $157 billion by 2020. It is well known that a major driver of these surmounting costs is the rising cost of chemotherapy and other treatments, in addition to the variation in how these treatments are used across the health care system.  However, there are several ways that providers, payers, and patients can work together to establish a more medically and financially effective cancer care model that also reduce costs and inefficiencies in the system.

Develop “clinical pathways” to reduce inappropriate use

For many cancers, there are multiple drugs that can be equally effective in treating a patient’s condition, but the price of these treatments can differ in cost by tens of thousands of dollars. Currently, oncologists are responsible for purchasing their own chemotherapy drugs, processing and maintaining them in a specialized pharmacy-like set up, and then administering them to their patients. Insurers then reimburse the oncologists for the cost of the drugs plus a margin to defray the price of maintenance and administration. Since oncologists receive a share of their income from the margins on the drugs they prescribe, insurers assert that there is an incentive to prescribe the pricier drugs, even when lower cost options of equal effectiveness exist.

Source: The Hill

Oncology Management Podcast Series with Bill McGivney

Welcome to the Oncology Management Podcast Series - Presented by IIR's Annual Summit for Oncology Management. Joining us today is Bill McGivney, Principal, McGivney Global Advisory LLC & former CEO, National Comprehensive Cancer Network

Download the complete podcast & transcript here.

To begin, could you please comment on what appears to be a seemingly never-ending call to define value in healthcare?

Bill: To answer your question about the definition of value in healthcare, you know I really do continue to be amazed at the calls that come out of national committee meetings and publications, etc. to say that we continue to have to define and develop a national standard for what value is in the healthcare system. To me, it seems really simple. I mean, I’ve been around the healthcare system for almost 30 years now. The value is the clinical benefit derived by patients, specifically, for the expenditure of a specified amount of healthcare dollars. That’s pretty simple. Sometimes when people try to develop these long equations to which I’ve seen, it’s a gust of bodies when they have their conferences. I mean, I saw one once years ago and I just commented to the moderator of the session that one, the long equations for the definition of cost effectiveness was mind-numbing and two, it would never see the light of day. I was right on both accounts. 

So, I think my simple definition is pervasive in terms of this is what value is. It’s really, again, the clinical patient benefit that’s obtained for a specified expenditure of healthcare dollars.

Download the rest of the Podcast here.

To hear more from Bill, please join us at IIR’s Annual Oncology Management Summit, July 21-23 in Philadelphia, PA.

To save 15% off your registration rate, use the code: XP1914BLOG

Register Now!

Oncology Management Podcast Series with Bill McGivney

Welcome to the Oncology Management Podcast Series. 

Joining us today is Bill McGivney, Principal, McGivney Global Advisory LLC & former CEO, National Comprehensive Cancer Network. Below you will find a teaser from Bill's podcast session, click here to listen to the complete podcast and to download the transcript.

How and to what extent do various stakeholders bring value to the treatment of patients with cancer?

Bill: Well, I think that’s something that we really need to look at closer because there are a lot of discussions, obviously, about the level of healthcare expenditures and the increase and rate of rise and expenditures of care to treat patients with cancer.

First of all, you look at providers and clearly their expertise, their acumen and their understanding is really about providing what the optimal treatment recommendations are for patients. Carrying out that treatment plan brings a lot of value to the system.

And then you look at the manufacturers, the biopharma companies, the medical device companies and they bring innovative products to the market that address the many, many needs and unmet needs that still exist for the many different types of cancer specifically. And that’s critical. They bring value to patients directly.

Then, you start to get down into other areas of the healthcare system that are more management operations oriented and you look at managed-care companies. They bring value in the sense that they help to organize the system. They pay the claims and the develop networks of clinicians to work with patients specifically.

But, really, what I think we need to do is, as we expend resources to bring care ultimately to patients with cancer, we really need to take a closer look at, again, which components, which stakeholders bring actual value to the treatment of patients.

Download the rest of the Podcast here.

To hear more from Bill, please join us at IIR’s Annual Oncology Management Summit, July 21-23 in Philadelphia, PA.

To save 15% off your registration rate, use the code: XP1914BLOG

Register Now!

Register for the Oncology Management Summit by Friday 5/23 to Save $400!

The recent debate over healthcare reforms has made one thing clear: unsustainable costs are leading to fundamental shifts in the way cancer care is delivered. There is a growing expectation that healthcare represents good "value".

As a stakeholder within the cancer care value chain many complex issues vie for your time and attention. You must simultaneously grasp the big picture, staying abreast of the changing oncology landscape, and keep focused on the day-to-day concerns that impact delivery of effective and efficient patient care. At IIR's Oncology Management Summit you will walk away with solutions to the most critical issues: cost, access to care, incorporating new technology, and meeting standards for patient-centered care. Oncology pioneers provide an understanding of the big picture, but also with practical, useful information to help you improve care now.

IIR's Annual Summit for Oncology Management is your 360° view of the cancer value chain; where stakeholders and influencers including payers, providers, hospital systems, leading cancer centers, and pharmaceutical executives convene to discuss how to control costs, increase quality, determine value and improve overall patient experience for cancer care.

For a more detailed look into the Oncology Management Summit, download the agenda.

To learn more about the evolution of cancer care, join us July 21-23 in Philadelphia, PA. Register by this Friday – May, 23rd and save $400! Just use the code: XP1914BLOG


Register Today!

Summit for Oncology Management Podcast Series with Dr. Ronan Kelly of John Hopkins

Summit for Oncology Management Podcast Series

Below is a teaser from our podcast series with Dr. Ronan Kelly...

Director of Gastroesophageal Cancer Therapeutics Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and the Medical Director of Global Oncology, John Hopkins International

Download the full podcast & transcript here.

To begin, the Institute of Medicine has declared that cancer care in the US is a system in crisis. Do you agree? 

Dr. Kelly: The word “crisis”, I think, may not be the best word to use. I certainly think that major changes are needed. If we, as a cancer community, do not take ownership of some of the problems that we will talk about today, then I think others will make the tough decisions for us.
What we have learned, especially in the last couple of years, is that costs will not constrain themselves and that we really are reaching a tipping point where we need to take definitive and direct action. Often, some uncomfortable actions will be required to get on back on path.

Some of the trends that are amplifying the crisis – as pointed out by the Institute of Medicine – is that we do have an aging population of, thankfully, more and more survivors. But, what we are seeing is a 30% increase in cancer survivors by 2020 as a result of many of the significant scientific treatment advances that we’ve been able to achieve in the last couple of years. But we are also seeing that the incidence of cancer is expected to go up approximately 45% by 2030. So, because of these changing or increasing patient survivors and increasing cancer numbers, we are seeing that the cost of cancer care is really, really going up. In the US we are expecting between 2010 and 2020 that there will be a 39% increase in the cost of cancer care up to $173 billion and some experts are even saying that this may be conservative estimate.

So, I think we certainly need to make changes. The current system that we have right now is not sustainable. So, some direct and often uncomfortable actions will need to be done in order to get us back on track. And to ensure that we continue to treat future generations with better and better treatments. So, some decisions are needed right now. I would agree that the system needs to be altered and, in some cases, needs to be dramatically fixed.

To hear more from Dr. Kelly, please join us July 21-23 in Philadelphia, PA for IIR's Summit for Oncology Management. 

To receive 15% off the standard registration rate, use the code: XP1914BLOG

Save 15% today, register now.

New Healthcare Delivery Systems & Programs To Reduce Costs in Cancer Care

KEYNOTE: Adopting a New Cancer Care Payment Model — United Healthcare’s “Bundled” Payment Pilot Program to Deal with Cancer Drug Costs and Reward Physicians for Health Outcomes: In 2010, UnitedHealthcare launched its own episode payment pilot program with five medical oncology groups around the country focused on determining best treatment practices and improving outcomes. Hear from Lee Newcomer, SVP, Oncology, Genetics and Women’s Health, UnitedHealthcare the rolling results of the program, lessons learned as well as feedback from physicians.

Models of Collaboration between Payers and Providers: The Implementation of Cancer Clinical Care Pathways: Panelists from National Comprehensive Cancer Network/NCCN, Cardinal Health Specialty Solutions and Aetna will evaluate the potential role of pathways in cancer care, and examine whether the implementation of clinical care pathways in cancer have proven to truly reduce resource utilization and improve the quality of healthcare.

PILOT PROGRAM SPOTLIGHT: CMS-Sponsored Pioneer ACO: In Michigan, Priority Health signed medical home contracts with several leading oncology practices who are required to comply with standardized treatment regimens of their own choosing. At the end of the year, oncology practices that have reduced Priority Health’s hospital and ED costs will receive “shared savings,” meaning that the insurer will share part of the savings with the practice. Hear from Barbara Walters, MD, Executive Medical Director, Dartmouth – Hitchcock on the results from the shared-savings between payer and provider and how Priority Health changed the way care and services are delivered.

Delivery and Payment Reform in New Value Based ACO Models: Get an industry update from Centura Health and Dartmouth – Hitchcock on the ongoing change in the ACO contracting arena, and discusses the ACO journey for new payment and delivery models that will focus on value. Assess how this will impact the future of cancer care.

To learn more, download our brochure.

As a reader of the healthcare insights blog, you can use priority code XP1814BLOG to receive 15% off of the standard rate to register. If you have any questions or need any further information, feel free to email kdevery@iirusa.com or visit the webpage.

We look forward to seeing you in June!

Best,
Oncology Management Team

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