March 2013 Edition Vol.11, 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 (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 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.

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