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Video Transcript: Oncology Outlook: Real-world Insight from Inside a Practice

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Gina: Patient access to medications. Declining reimbursement. Changing interactions with managed care. How are community oncology practices and pharmaceutical manufacturers working to confront these issues? Join us to find out. “In the Know” starts now.

Hello and welcome to “In the Know,” your source for insight and analysis on the issues that matter to specialty pharma. I’m your host, Gina Clark.

Today, we explore the recent developments in community oncology, one of the most dynamic and closely watched markets in the specialty pharmaceutical space. We’ll hear how oncology practices are rethinking the way they operate, and how manufacturers, payers, the US government, and even technology companies are poised to influence the future of cancer care. Here to address this with us are Alana Vaughn, Practice Administrator for Louisiana Hematology Oncology Associates and Bobby Pope, Vice President of Sales for ION.

Welcome to you both.   

Bobby: Hey Gina.

Alana: Hi Gina.

Let’s start with a broad question for both of you: in what ways is the oncology market different today than it was five years ago—or even as recently as two years ago? What are some of the more significant changes you’ve seen?

Bobby: Yeah Gina, I think we’ve seen changes, well obviously on several different fronts. Number one, probably the biggest, has been changes in private practice economics and the way oncologists are reimbursed for their time, and also the way drugs are reimbursed. You know the methodologies have changed, and it changes the way oncologists have had to look and approach their business. I think there have been major changes, positive changes on the clinical development front. There are many more players or manufacturers now in oncology that have invested a lot of money or resources in drug development, so you have a lot more targeted therapy, you have an increase in biological therapy. This has allowed for more personalized medicine. You’ve also got oral drug therapy, which has obviously helped with patient convenience and quality of life. There are changes in technology, you know, five, ten years ago technology wasn’t a big buzz word. Now it’s become a necessity in most practices. So I think there you’ve seen, you know, on three fronts, a lot of different changes that have really shaped a new paradigm in oncology, and the way that oncologists are going to practice medicine moving forward, and really changes that may challenge or in a lot of ways, possibly improve patient access to quality, affordable care.

Alana, your thoughts?

Alana: I think Bobby is right on track. And as you expound on what Bobby says from a practice standpoint, efficiency really is the key word for what we do in a practice. We have to be very efficient, we have to be very diligent in the resources that we have available, and what we do. We’re having to keep track of so many changes – changes in the revenue structure, the reimbursement structure for us. We’ve got changes in coding that keeps coming about, changes in the insurance options that patients have available to them, and how those options affect us within a private practice. It is so dynamic for a practice now. We’ve got to be fluid; we’ve got to continue to change very quickly as to what happens to us. 

Alana, what impact has changing reimbursement had on the way your practice operates? How has your practice adjusted as a result of reduced reimbursement?

Alana: We have to look at things from a standpoint of, “How are we efficient in the delivery of that care, how can we turn around and look at the resources that we have available?” We’re continuing to review processes, procedures that we do. How can we revamp that? We’re having to look at educating staff all the time, because it’s changing for us. And in addition to that, we’re having to look at the resources that are available to us, whether that’s our labor or whether that’s monetary. How do we streamline? How do we save money? How do we do the best that we can do by a patient, by keeping track of the resources we have and by minimizing what we have to spend. 

Bobby, you spent more than a decade working in pharma and only recently joined ION. What has changed about the way pharma is approaching the community oncology market? Does the interaction between pharma and oncology practices differ these days? To what do you attribute this difference?

Alana: That’s a great question. I’m not sure if that relationship has changed, but I do know that community oncology, if you think back years ago, and probably even today, much of the drug development occurs in the academic setting. However, we do know now, and I think “we” meaning pharma, realized that most of the patient access to care, probably over 80% of it, occurs in the private practice or community setting. And I think that recognition has really changed pharma’s approach, I think evolved pharma’s approach to community oncology, in the sense that they know how important it is to deliver key clinical information and clinical data to key decision makers. I think at the same time they realize how important the access to care and access to their products are at the community level. So I think that’s probably changed a little bit in terms of how pharma approaches community oncology. I think the other dynamic you have working is that it is a crowded space, as I had mentioned before, with many more manufacturers having some type of drug development or even a product on the market in oncology. So that’s created a demand on how pharma accesses the physician and the physician’s time. So I think that Pharma needs to and has been looking at other ways and means to access the physician or the key decision maker. And also, how to deliver that key clinical information, whether that be through you know the web, or at meetings, or other methods of message delivery, and data delivery.   

Alana, is your practice working more closely with other practices during these times—either directly or indirectly through organizations like state societies or physician services companies like ION? Are you able to share best practices related to clinical or operational issues?

Alana: I think collaboration is really a key word in the whole question. The ability to work with companies like ION, companies that have resources available to them that we don’t always have within our practices. So we can look to companies to collaborate with, to help us operationally, whether it’s to secure contracts, or whether it’s to secure just information, whether it’s clinically for treatment options. State organizations are a wonderful area also, because you’re dealing with people who are in the same area, who have the same common problems that you may be having. Even dealing with practices outside of your local area is wonderful because you can share those best practice ideas, you can share information. “Well how are you doing it?” "Well how are you doing it?” That helps us all to stay on our toes, to deliver the best care that we can provide. That’s what we all want to do is provide best quality cancer care to our patients.   

How closely is your practice following health policy discussions and the debate around healthcare reform? What areas, in particular, cause you concern?

Alana: I think practices are much more engaged in following what’s going on in the healthcare industry and healthcare policies right now. Those policies, when they change, a practice has to adapt very very quickly. We don’t have a lot of time. You can’t wait two months to come up with a policy. You have to take the policy that was implemented, and change your practice guidelines and what you’re doing very quickly. So we do have to keep track of that. I think right now, one area that we’re looking at is a sustainable growth rate. That’s an area that’s not been rectified by congress yet. So that’s going to impact all of us, and not just the oncology industry, but the medical profession in total.  

Are there any areas that give you reason for optimism?

Alana: I think the area of optimism is that everyone is looking at the buzzword of quality cancer care. That’s what everybody wants to do. So I think there is a lot of great optimism, a lot of good things for us all to look for. How do we provide that best care? How are we going to all do that, and work together to do that? When we work together, it’s a win for everyone, and most importantly, it’s a win for the patients. That’s what we’re here for.  

Bobby, what are your thoughts on the evolving relationship between community oncology and managed care companies? What role can pharmaceutical companies play in this ongoing interchange between practices and payers?

BP: Well I think managed care or third party payers, as they’re a lot of times referred to, or commercial payers, has become a big buzzword in the space. Pharma has to pay attention to this, because at the end of the day it goes back to access to their products, to their compounds. An appropriate position in pathways and treatment guidelines, and the ability to do that is again the clinical data. How that data is captured, how that data is interpreted, is very important to Pharma. So I think Pharma needs to and will be putting resources behind capturing various types of data, whether it be clinical outcomes or pharmacoeconomic data. Aside from just the pure clinical studies that they do, I mean you have to look beyond that, and that’s going to become a very important part of how Pharma approaches this. The one thing I will say is that pharma does have on the primary care side, especially the bigger pharma companies that are in the oncology space, if you think about the primary care side of their business, they have extensive experience managing those products and those diseases on the primary care side, so I would hope that they could take at some point those expertise that they’ve learned in that area, and hopefully apply it oncology.  

Patients seem to be more educated about their treatment options today than they ever have been. Alana, has that impacted how practices approach their patients?

Alana: Patients come in today, and they’ve already been on the internet. They’ve already done their research; they know about their drug, they know about the disease that they have. So that they come in very empowered. What that does for us, is that allows us to take that information that they have and build upon it, to become very centered about what they’re having, and how it affects them. So the doctors, the nurse practitioners, the nurses, they all spend a lot of time on that education component, on making sure that they’re a part of their cancer care team. It’s wonderful when a patient feels very empowered, to be a part of that. We have seen great responses from patients when they feel very important in that team.     

In what ways have the introduction of new oral oncology products changed how patients receive care? What new challenges do they present?

Bobby: Gina, I think it has changed the whole paradigm, in terms of delivery of care. If you think about in the traditional setting where a patient comes in and gets their chemotherapy, whether it be weekly or monthly, they’re in the office. Now step back, and think about oral oncolytics. First you have a specialty pharmacy that the physician or the practitioner is dependent upon to deliver that medication to the front door of that patient. Secondly, what is the patient to do after they get their drugs? Are they taking them correctly, are they taking them on time, are they compliant, are they adherent? What about side effect management: are they reporting side effects, how are they being treated for side effects if there are side effects, and are they even getting their products refilled? A lot of times the physician is out of that loop with an oral oncolytic. On the positive side however, I do think that oral oncolytics have really broadened and deepened treatment options for providers and for patients. Many of these products are targeted therapies, and really have I think, added to again, the treatment options that physicians have and also have increased opportunities for patient convenience when they can’t or wouldn’t be able to or don’t want to travel to a physician’s office, or come in for a weekly or monthly infusion. They’ve also, with that, helped increase quality of life from that perspective.              

What about technology tools? What are practices asking for, and what can be done to remove some of the barriers to broad adoption of technologies like electronic medical records, e-prescribing and similar tools?

Alana: I think one of the barriers that many practices have to the implementation of that is it’s a financial barrier; it’s very expensive to create an electronic medical record in your office. It takes a lot of education for your staff, for the physicians, on how to implement that. It also means redeploying people, labor, how do we do things? You have to start to think, we have to restructure all of that. I think an EMR system is going to be crucial. I think the government has also begun to tell us that they want us to begin to adopt an EMR. I work with a practice where we have implemented an EMR in our office, and it does create many efficiencies, and it does create of course, certain challenges when you do that. One of the other things I would say about the EMR, is we hope that it’s really going to increase the quality of the care, but when you talk about increasing quality of the care, then we’re talking about, how do we measure increased quality of care? And I think that’s going to become an issue, that there’s going to be a lot of conversation about how do we do that?       

Looking forward, why is this an uncertain time to be in oncology? Why does it remain an exciting time to be in oncology?

Alana: The uncertainty goes back to the things that we’ve talked about. It’s dynamic, it’s fluid, it’s ever-changing. What happens today? It’s going to be different from tomorrow. But I think what that brings, is that brings new things. That brings new treatment regiments for patients that Bobby’s talked about. That’s what we’re about. The bottom line is, delivering quality care to patients and to help them live with what cancer’s becoming, a chronic disease in many aspects. So that’s what this is about, and I think that, for patients, is very exciting to see.

It looks like our time for today’s program is running short, thanks so much for joining us.

Bobby: Thank you, Gina.

Alana: Thanks, Gina.

And thank you for joining us—we’ll be back soon with another, all-new webisode. Until then, if it’s on your mind, it’s In the Know.

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