Empowering Community Oncology with Choices that Count: An On-conversation with Barry Fortner, PhD, Senior Vice President of Operations, ION Solutions

ION Solutions, an AmerisourceBergen Specialty Group company, is a physician services network for community oncologists. ION Solutions offers group purchasing services, technology and analytics solutions, as well as practice education that all helps community oncology practices improve their operational and clinical effectiveness.

ION Solutions has recently launched a new campaign, Community Counts (OurCommunityCounts.org), with a goal of uniting oncology practices around the idea of giving physicians a choice in where they deliver care and giving patients a choice in where they receive their care. By joining the campaign, practices will receive data that shows measurable cost advantages for cancer care delivered in the community setting. They will also receive tools they can use to communicate this data to legislators and payers. Spearheading the campaign is Barry Fortner, SVP of Operations at ION Solutions. We spoke to Barry so that we could get a better understanding of the goals of the initiative and how ION is helping community oncology. Here are excerpts from that interview.

OBR: Tell us in a few words what specifically you want people in the industry to know about the current state of the community-based industry?

Barry: First, I’d like to start by saying that private practice, local, community-based cancer care is a distinguishing characteristic of oncology. What I mean by that is other therapeutic areas have been more quickly absorbed into the hospital outpatient setting, but the characteristics of community oncology are such that it has continued to be the dominant delivery system of cancer care in the United States. This is supported by recent reports coming out of ASCO, from studies conducted by Avalere Health and Milliman, and a new white paper from Xcenda—which shows that 70% to 90% of chemotherapy episodes are delivered in the community setting.

This is an important fact for the industry to acknowledge since there is lively discussion taking place about developing new models of cancer care delivery. While these discussions are taking place, we have to be considerate of the fact that any alteration in the ratio of cancer care delivery will translate, we believe, into treatment access issues and quality of care issues, particularly in rural settings or in populations that are under-served. We want to underscore the value of local, privately owned community practices, as well as highlight the value these practices add to the pharmaceutical industry—since somewhere around 65% of doctors are in private practice in one form or another. We want everyone to realize that community-based oncology is a strong and vibrant option for patients and that community-based oncology is still the undisputed primary delivery system for cancer care in the United States. It’s important for the pharmaceutical industry, the government, payers, doctors, and the public, to have a complete understanding of this distinguishing characteristic.

OBR:  Well said. What in particular is the threat to community oncology that concerns you most?

Barry: Over the last few years we have seen more practices move appreciably from the community setting to the hospital setting. Satellite offices are closing, private practitioners are closing their doors, larger practices are emerging, and of course, practices are being consolidated into hospital systems. The threat to community-based oncology is real as practices are dealing with a number of challenges that impact patient access to care and potentially, clinical outcomes. As we have seen in the Community Oncology Alliance (COA) study, the number of oncology practices that have closed or moved to a hospital setting is steadily increasing. It has gotten to the point that we can actually count the number of practices closing, and every year more practices struggle to stay in business. People who are interested in ensuring access to novel medicines nationwide and delivering the highest quality care in every nook and cranny in the country have to be interested in seeing that community oncology remains viable.

OBR: Right, we see the numbers of practices closing every year as well. Can we expand on that? What is the message here?

Barry: We believe that all sides of cancer care, from the academic institutions that are dedicated to cancer advancement to the community practices concerned with delivery of quality care, are striving to advance patient outcomes. But at the moment, the at-risk segment is the community-based segment and therefore access to treatments and quality care at the highest level. Moreover, at risk for the pharmaceutical industry, is a landscape in which the proportion of professional activity and access to physicians may change. So, it’s this equilibrium that we believe is being disturbed by external pressures that are not related to patient demographics or socio-economic elements that one would prefer drive a market place. Instead, these are external factors, and in particular, change in Medicare reimbursement. And I think that it’s in the pharmaceutical industry’s best interest to be acutely aware of the fact that there are many dynamics of how an innovative drug is brought to market and that the community setting provides a very positive step with bringing innovation forward.


Empowering Community Oncology with Choices that Count: An On-conversation with Barry Fortner, PhD, Senior Vice President of Operations, ION Solutions (continued)

OBR: OK. You’ve established that the threat is real, now tell us about Community Counts and how does that campaign fit in with what you’re talking about?

Barry: Community Counts is a national educational campaign that highlights the value proposition of community oncology and highlights the risk of losing that value proposition and its consequences. It is the goal of the campaign to empower and equip physicians and to educate themselves through their own outreach. Our hope would be that through this campaign, we can impact the evolution of healthcare in respect to oncology and that we would be able to have input into the narrative regarding value, cost effectiveness, and health outcomes. It is our desire that through Community Counts we have a positive influence such that what emerges is a healthcare model that promotes value in cancer care, and that community oncology will be a significant component of that value equation. The campaign is meant to empower physicians and the public and provide information that will impact a conversation that will lead to an enduring and healthy model for community oncology.

OBR: When did this campaign start?

Barry: This year. We launched in Philadelphia on January 22 and continued the campaign in meetings in Phoenix, Chicago and Atlanta. Since the first meeting, we have launched the Community Counts website, where multiple tools and educational forums will be launched over the coming weeks.

OBR: Can you give me an example of some of the education that took place in Philadelphia, Phoenix, Chicago and Atlanta?

Barry: First, ask yourself the questions: Is community oncology delivering quality care, is there value in it, and if we want to produce more value in the coming years, is community oncology part of that equation? Our literature would clearly detail a very strong argument in support of community oncology. When we talk about an evolving, emerging model of value-based cancer care, we can’t restrict access and have improved value. Whether it is a rural patient or a Medicare patient with no secondary insurance, the average American is receiving care in a local, privately owned community oncology practice. So when it comes to access, the argument falls on the side of community oncology.

We’re showing data that do not support the idea that quality in the community setting is sub-par compared with other potential sides of care. In fact, our literature suggests that community oncologists are largely compliant with national guidelines; they were innovators in the clinical pathways movement and are showing significant uptake in pathways. The data suggests there is relatively little off-label use. And the reason is because there’s not a need any more to go off-label, since a robust oncology portfolio has been developed through the innovation of the pharmaceutical industry over the last 20 years. Through multiple lines of therapy within major disease types we have multiple options, and so the accusation that physicians are using off-label is unfounded.

Moreover, in the last 2 years, beginning with the Milliman publication in 2010 and continuing with the recent white paper completed by Xcenda, we’ve had a series of studies that really have documented that community is a less expensive side of care, compared with hospital outpatient centers. And, that’s true for Medicare patients, where even though the payments are relatively even, with some small exceptions, the pattern of care and the way that care is utilized results in a differential cost advantage for the community practice. On the private side, there is a more pronounced differential in costs, primarily because private payers are contracted differently with community oncology than they are in other settings.

I do believe that there are exceptions, for instance regions with higher indigent populations have other needs and justifiably higher costs, but when you look at cancer care as a whole, our point is that the lower cost option—with equivalent quality but with a higher potential for access that is represented by community oncology—is a phenomenon that needs to be valued and that we need to protect. And so, the education point is that there’s available data to make a cogent argument on behalf of community oncology that we didn’t have 5 years ago. We didn’t even have that data in 2003 with the installation of the Medicare Modernization Act. We now have a significant body of literature that supports the value proposition of community oncology.

OBR: Is your white paper accessible on the OurCommunityCounts.org site?

Barry: Yes, it is. Basically, that paper took a look at the results of Milliman and Avelere and noted some analytic shortcomings, namely the failure to take into account the potential difference in severity of disease by site of care. Maybe the reason hospital outpatient settings cost more is because they’re getting the sicker and more complicated patients. One of the fundamental contributions of the Xcenda paper is that it took those differences into account and then performed an analysis of those differences that we could measure in the large scale databases. The results were quite profound. We went deeper into describing those differences not only by disease type, but within broad treatment categories and down to specific regimens within treatment types within disease categories. It was a methodological improvement.

Empowering Community Oncology with Choices that Count: An On-conversation with Barry Fortner, PhD, Senior Vice President of Operations, ION Solutions (continued)

OBR: So that’s an example of an educational tool available now.  Any other tools we should be talking about?

Barry: We have released the first of a series of core slide decks. These decks summarize the literature that can be accessed in multiple forms that a practice or an interested party can download and then use in their own presentation or adapt to their own practice. This broad body of literature I referred to is a significant effort to digest, and Community Counts provides that literature to interested parties in a way that can be used in communication efforts.

OBR: And, the intended communication is physician to other stakeholders, including Capitol Hill and their legislators, correct?

Barry: Community oncologists have to represent themselves.  There’s simply no way around the fact that their relationships with thousands of patients is something that they treasure, but they treasure it quietly.  Community oncologists are going to have to reveal who they are and what they are doing so that payers, the government, employers, even their own communities can recognize and acknowledge what they’re doing.  Ultimately, we need all community-based oncologists to be able to represent themselves in a more vocal and visible manner.

OBR: How else can Community Counts help?

Barry: We have a series of webinars that will be expanded. Some are more aimed at payers, some at employers, or at practices. The Community Counts website has in effect a call to action capability so people are able to come online and send a message to their local representative. We will be releasing a broad range of tools over the coming weeks in which various constituencies are targeted and the nuances of the messages may receive attention.

The four-city tour is not the end of the campaign. The campaign will be an enduring effort as the healthcare debate is not something that will end any time soon. This effort of ours is ION Solutions showing our commitment to the marketplace and to our customers. We believe that this is a national dialogue that will continue for many months if not years, and we want to make sure that community oncologists are properly represented in this ongoing conversation.

OBR: Back to the live meetings, can you give me an example of the faculty at these meetings?

Barry: In Philadelphia, Dr. Jeff Vacirca showed a compelling video where he was telling the story of his community practice and he really made an appeal to his colleagues about appreciating and understanding the value proposition of the community oncology as a profession. He emphasized the call to action in a peer-to-peer manner. There’s an array of folks involved in the presentations, but at the heart of this it really goes back to an awakening amongst community oncologists to have a hand in shaping the future of their profession.

There’s no doubt that we have a special relationship with the 4,500 physicians and 1,600 practices in the ION Solutions network; that’s a majority of the community market. We’ll leverage the intimacy of those relationships, but I think it is important for us to communicate that this is not just about the ION Solutions member practices—this is open to any community practice, and again, it’s for the welfare of the industry. All our events are open events and are attended by practices regardless of their affiliation.

OBR: That is important to communicate. I like the fact that you’re trying to make this kind of turnkey for practices to use your resources to go directly to their legislators, employers in the region, or to their regional payers.

Barry: We do have partners that are interested in supporting these efforts, and the entire industry is able to help in certain ways. Ultimately, the profession needs to represent itself in terms of large-scale communications and mass media efforts. We are very thankful that the industry is showing support and coming to the aid of community oncology.

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