Stakeholders engage in innovative strategies driving cancer outcomes in New Jersey

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At the 70th Annual Roy A. Bowers Pharmaceutical Conference, key stakeholders involved in the delivery of cancer treatments in New Jersey discuss strategies for driving innovation in oncology and remaining challenges that hamper its integration.

Recognizing the value-based aspects driving patient outcomes in oncology, effective cancer treatment in New Jersey has been redefined to integrate cost and health equity at the forefront of innovation. Telemedicine, home care and biosimilars have all emerged as potential solutions to reduce increasing financial toxicity and access concerns in oncology, but there remains a significant need for collaboration and coordinated strategies to optimize population health, stakeholders noted during the 70th Annual Roy A Bowers Pharmaceutical Conference: Innovation Through Crisis – Redefining Healthcare.

Opening the final panel of the conference, hosted by the Ernest Mario School of Pharmacy in Rutgers, The State University of New Jersey on Monday, was Edward Licitra, MD, PhD, Chairman and Chief Executive Officer, Astera Cancer Care recognizing the usefulness of the recently completed Oncology Care Model (OCM) in delineating the level of sophistication required to address general (dehydration, chemotherapy-related toxicity) and complex (reimbursement, social determinants of health). [SDOH]) problems for patients in a personalized way.

“We recognized that since many population-based, risk-based oncology models require treatment of populations of patients with breast, pulmonary, and — or colon cancer,” Licitra said.

Astera first worked with Horizon to create an episodic treatment plan for breast cancer patients, and now, according to Licitra, there are a total of 18 different programs launched by its organization in oncology. In addition to bundled payment models, he said some beneficiaries are also offered services not typically reimbursed by Medicare for a fee, such as B. Next-generation sequencing.

“We believe we can actually roll up at least 50% of cancer cases under prospective epidemiological payment agreements, which we believe we can then integrate into values-based care programs and population health initiatives that allow us to provide services, including home health services, to these patients, and.” then ultimately control the cost of care for the provider, the patient and the payer,” he said.

Steven K. Libutti, MD, FACS, director of the Rutgers Cancer Institute of New Jersey, added that the use of pooled payments also has potential in palliative care, or as he described it, “supportive care.”

Episodic schedules are typically provided to patients in the early stages of the disease, in part due to the minimal variability observed in these disease types. However, introducing these payment models for patients in more advanced stages of the disease can have a significant impact on quality and costs, Libutti said, as care teams are often reluctant to transition to supportive care.

He noted that expanding the continuum of care from the time a patient begins treatment to the point where viable therapeutic options can no longer be considered can prove particularly beneficial to providers, payers, and other members of the care team who may have difficulty recognizing when to treat options are exhausted and turning to supportive care is ultimately the best option.

“At some point, it may not be in the patient’s best interest to go into fourth-line therapy and understand that and make a plan with the patient early on – how far the journey will go and what they might need towards the end of the journey, if.” We’re not meeting the goals that we were all hoping for — I’d love if we fleshed that out further as part of these packages,” said Libutti, who also serves as vice chancellor of cancer programs at Rutgers Biomedical and Health Sciences and senior vice president of health sciences oncology services at RWJBarnabas Health.

In overall oncology care, clinical trials are also a cost-effective alternative to provide standard of care at a lower cost than would normally be associated with these therapies. The results of an analysis by Tennessee Oncology examining the costs of treating patients with 8 different malignancies who received Medicare as part of the OCM showed that those enrolled in a clinical trial compared to participants , who participated in a clinical study, showed an 18% reduction in episode costs were followed up regularly.1

Partnerships with payers, along with bundled payment models, are also key to covering costs that would otherwise be imposed on the patient, infusion center and private practice, Libutti said, and increased clinical trial integration can also reduce the use of third-party providers and “desperate agents.” ‘ of the fourth line, which contribute to waste.

“Not that it’s easy, but it’s one of those things that if you have an organization that can bring a relatively high percentage of patients to justice, you should be rewarded for that, because I think there are benefits, which are approved for patients and also payers,” Licitra said.

Because the standard of care for drugs in oncology is between $15,000 and $20,000 per month, Michael P. Kane, RPh, BCOP, Executive Director, Oncology Services, Rutgers Cancer Institute of New Jersey, RWJBarnabas Health, noted that the selection criteria for clinical trials is key, as it often excludes the types of patients who typically present at the clinic.

“I’d love for the population contributions to say, ‘Hey, you have these exclusion criteria for diabetes – why is that when half the patient population has this disease?'” Kane said.

Even in cases where there is consensus on the optimal therapy for a particular patient, he stressed that when applying for insurance approval, they still get denials because the drug may not be part of clinical benchmarks, such as: B. established recommendations of the National Comprehensive Cancer Network (NCCN).

“So how do we bridge these patients from something that doesn’t have an admissions compendium, isn’t yet part of their payer policy, but we know it’s the best care? What I think would be a better model, if you get a drug this way, there has to be a way to collect the data to know if it was worth it.”

Financial navigators and social workers were other important resources Kane mentioned for addressing financial toxicity associated with caregiving as well as SDOH issues outside of the clinic, including cost of living, transportation, and food costs.

“I think the most effective thing we can do is continue to have the modalities for frequent touchpoints for patients. It’s everything from telemedicine to remote patient monitoring to apps because I think all of these things lead to better outcomes, control costs and improve efficiencies,” Licitra said.

“One of the biggest concerns I see in my own healthcare system, and this relates to an unwillingness to get rid of old ideas, is the fact that these technologies kind of create a barrier between you and your colleagues or you and your patients. And I don’t think that’s true. I think it’s about execution,” Libutti added.

“Wouldn’t it be great to be able to monitor some of the things that are going on with your patients in real time, so you don’t have to wait every week or month to find out how they’re doing with their medication or how they’re doing in relation to it on the side effects of toxicity. If I had a blank check I would invest it in the proper implementation of these technologies.”

Relation

1. Young G, Bilbrey LE, Arrowsmith E, et al. Influence of participation in clinical trials on episode costs in the Oncology Care Model (OCM). Presented at the 2021 ASCO Annual Meeting. https://bit.ly/3dvr8GY

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