March 2013 Edition Vol.7, Issue 3

Community Counts: A Discussion With ION Senior Vice President Barry Fortner, PhD, Regarding a New Initiative to Help Community Oncologists

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 (, 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.


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