July 2013 Edition Vol.7, Issue 7

An OBR Survey: Ownership and Usage of Oncology Treatment and Diagnosis Data

An OBR Survey: Ownership and Usage of Oncology Treatment and Diagnosis Data (cont.)

Cancer Patient Data Aggregation via “Pools”

Companies with an interest in oncology data—be it EMR vendors, patient portal vendors, pharmaceutical manufacturers, and even payers—will find that most oncologists today want to be more proactive with their patient data, but until now few have had the time.

“There are benefits to aggregating data but it should be done by oncologists who can properly do it and properly identify patterns,” said a Washington-based oncologist just 3 years out of medical school.

Seventy-six percent (76%) of respondents believe aggregating data is one of the few ways to ultimately draw conclusions and advance cancer treatment decision-making. Aggregating data can “eliminate bias” and either validate or “debunk beliefs about practice treatment patterns, referral patterns” or other oncology trends (Figure 7).

“It’s simply less biased and more statistically relevant if aggregated,” noted a hem-onc from a small group in Connecticut. “It’s important in oncology to create evidence based protocols and aggregated data is one way to get there.”

Twenty-five percent (25%) of respondents admit that aggregating data may do little to influence individual prescribing behavior, “because each cancer patient’s tumor is different”, but over time may have value to them. There are also inherent risks in pooling data that practices say they would have to address, like how to create a system based on best practice and aggregation “when aggregated data creates benchmarks from blending in bad practices.”

Despite these challenges, by pooling data with other practitioners, most surveyed oncologists believe they can accomplish several business objectives in the next 2 to 3 years—build more demand for their data, create leverage with vendors and payers, and establish a more organized and financially beneficial approach to data exchange.

The pooling data trend is similar to the way many oncologists reacted to reimbursement cuts in the wake of the Medicare Modernization Act of 2003, by adding diagnostic imaging to their offerings, or in-office dispensing in 2008 as a way to offset reimbursement cuts and bolster revenue.

Today, 68% of respondents said the impending changes in healthcare, such as the Affordable Care Act and birth of healthcare exchanges, “worry” many who say they are looking for non-traditional revenue streams.

“I think we can benefit by more group partnership – see how we can pull our data together,” according to a partner from a group of eight oncologists in Missouri. “Obamacare has changed how we have to protect our practice.” Others said, “pooling” data may be complicated initially given that community practices compete, but may also become “necessary” to gain leverage with payers. “Even if not successful with a Cigna or United at least we can offset that by selling to others.”

Figure 8 reveals that few practices are compensated for sharing data today, but this will probably change.

Most compensated for sharing data are benefiting indirectly at this point through their practice or organization, including several large regional oncology groups that allow vendors to access their patient data in exchange for research, analysis and ultimately shared savings or revenue returns for achieving higher quality performance.

Several larger groups who have used their EMR and staging data to demonstrate their overall value to health plans have negotiated reimbursement increases in exchange for sharing data. One group in Colorado that considers itself the only group in town, negotiated with a regional Blue plan, sharing data related to readmissions, treatment patterns, and pathway compliance, in exchange for higher administrative fees and potential savings for meeting certain objectives.

“It’s a tiered system – we provide data back to the plan so the more data we share and the more of us who comply with the pathway, the more we save the plan and the more we share in savings.”

The group’s total adjusted savings share in 2012 was $125,000, mostly due to reductions in 30- and 60-day hospital readmits for lung and breast patients.

Overall, few of the practices surveyed (less than one-fifth of large groups and none of the small groups) admit success using data to educate health plans about their value in reducing downstream cancer care costs (Figure 9).

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