The 4 main trends that are changing oncology practices
What are the most distinguished trends in cancer care that can touch the strategic planning, budget, and bottom line of an oncology practice? The Association of Public Cancer Centers (ACCC) partnered with the Advisory Board Company to identify some of those trends in the 2017 Survey of Current Trends in Cancer Care. The survey results were presented at the Annual Meeting of ACCC 2018 and at the Business Summit of the Cancer Center.
Deirdre Saulet, PhD, Practice Manager, Company Advisory Board, moderated a session at the ACCC meeting on key trends in cancer care and strategic novelty in oncology practice. She spoke about the results of 2017 Trends in Cancer Care Survey and what they mean for oncology practise managers and providers.
A total of 291 providers responded to the survey of trends in cancer care: 52% were from a non-teaching community hospital, 37% were from an academic medical centre or teaching hospital, 5% were from independent medical practice, and 4% were from an independent cancer centre. The remaining 2% came from an oncology hospital exempt from the prospective payment system.
According to the doctor, the survey revealed 4 main trends in cancer care that are affecting cancer program strategies the most:
Cancer case rates are increasing, along with increasing competition for cancer programs. Although new cancer cases in the United States are projected to rise to 1.91 million in 2026 (up from 1.57 million in 2016), 19% of cancer program leaders surveyed reported that competition has increased significantly for most cancer programs, and 39% reported that competition has increased slightly. On a more regional scale, 32% of academic cancer centre respondents reported that competition in their market has increased significantly in the past 24 months.
- Repayment is at a tipping point
- Cancer patients begin to act as consumers
- Precision medicine is revolutionizing cancer treatment.
2020 trends in cancer care
While 2019 brought many changes to the cancer care landscape, 2020 promises even greater disruption to business as always. For cancer administrators and healthcare leaders, two timeless truths remain, as life expectancy and an aging population continue to grow:
- Doctors diagnose more people with cancer than ever before
- The cost of caring for cancer patients is higher than ever
Cancer treatment, the second leading cause of death in the US behind heart disease, is the largest driver of care costs, amounting to approximately $ 150 billion in healthcare expenses. Creating a more sustainable, holistically-minded model for cancer care is an industry imperative, one in which we expect providers to make significant strides in 2020.
Six Key Trends in cancer care for 2018
The six key trends in cancer care for 2018 may include:
- Less chemotherapy
A recent report discovered that among patients with the most mutual form of early-stage breast cancer, chemotherapy prescriptions fell, overall, from about 34.5% to 21.3%, in a recent interval of 2 years (2013-2015). That’s a big drop, from more than a third of women with stage 1 or 2 diseases who receive chemotherapy to just over a fifth who receive chemotherapy. This trend is impressive and credible in a context of growing discussion and awareness of overtreatment and (although the authors of this particular study found no link) a wider use and acceptance, among oncologists, of recurrence predictors such as OncotypeDx and MammaPrint.
- Concerns about the costs of cancer drugs
This problem is not going to go away. Rather, the problem of the financial toxicity of cancer, for individuals and society, will increase as more drugs become available and can be prescribed. Some argue that cancer drugs should not essentially be enclosed by private insurers or public underwriters (Medicare or Medicaid) unless the cancer treatments demonstrate a certain level of benefit to patients. But how oncologists, patients, economists, or insurance administrators define “benefit” or “value” is controversial, as is how that benefit should be demonstrated.
- Focus on diagnosis, quality, and payment for cancer genetic testing.
This is a crucial issue for patients with malignancy who want to try new anticancer drugs and need to know if their tumors harbor molecular characteristics that match those new drugs. Currently, CMS is weighing whether Medicare and Medicaid should pay for next-generation sequencing (NGS) of advanced cancer cases. So far, the FDA has approved just one such pangenetic cancer test, FoundationOne CDx, which costs about $ 5,800.
- Prescription of anticancer drugs independent of tumor
This modern way of prescribing cancer drugs, based on molecular changes in malignant cells, and not necessarily where in the body the tumor occurs, such as “breast” or “colon”, makes sense. In general, I see this as the future of oncology.
- Patient-reported outcomes
It matters how cancer patients feel. It has always been that way, but doctors (and policymakers) didn’t pay as much attention to their subjective descriptions of pain, nausea, tiredness, and other symptoms. As more cancer drugs become available, Patient Reported Results (PRO) will allow clinicians to identify subtle differences between what some consider “me too” drugs and also weigh the risks and benefits of the treatments they provide. they can, or more, no, do more good than bad.
- Artificial intelligence (AI)
Few physicians, even subspecialized oncologists, can keep up with advances in the field. Whether it’s IBM’s Watson, which I remain optimistic about, or another AI brand providing suggestions, data-driven algorithms will be needed to guide doctors’ recommendations. The emerging field of computational biology, which can take big data and apply it to individual patient cases, with recommendations based on real-time knowledge of cancer science and approved treatments, is the way to go.
Trends in cancer care and what it means for oncologists
Oncology has undergone more constant change in the last thirty years than from the late 20th century to the time cancer was first identified in 440 BC. C.
The rapid pace of innovation in oncology has been driven by an immense explosion of knowledge about cancers, how they grow, and how to treat them in different subpopulations. In fact, from May 2018 to May 2019, the US Food and Drug Administration (FDA) approved nearly 60 new cancer drugs. And while the advances we see in oncology today – targeted therapies, accurate diagnoses, and a better patient experience – are driving a steady drop in cancer death rates, they also require oncologists to know more than anyone else.
So how should medical oncologists and their practices keep up with developments to ensure that the patient receives the right treatment at the right time?
Oncologists and their practices cannot be overwhelmed by the promise of artificial intelligence or any other aspect of technology and instead focus on two vital deliverables: 1) an agile platform that turns clinical, operational and financial data into insights actionable; and 2) a platform for real-time peer communication that offers a virtual second opinion. Technology must work to improve workflow and efficiency for physicians. By engaging physicians and focusing on meeting their needs, the technology and analytical insights it reveals should help oncologists not exacerbate physician burnout.
Former House Speaker Tip O’Neill’s saying that all politics is local also applies to healthcare. Every market in the US is different and requires practices looking to thrive in order to have the flexibility to form partnerships that make sense locally. One size fits all does not work for oncology practices or their patients today. Rather, practices need the flexibility to form relationships with hospitals or other provider networks that make sense for their patient populations.
While flexibility is important at the local level, practices cannot survive without the scale to negotiate drug purchases, contracts with payers, or relationships with employers. Clinics don’t have to sacrifice independence for scale, but they can’t do it alone, and they hope to be able to offer their patients services throughout the continuum of care, from clinical trials to palliative treatments. Clinics must find working partnerships so that options for care, especially access to clinical trials, are expanded for patients.
Pay-for-service care will soon be akin to skiing in jeans, a relic of the 20th century. Medicare’s risk-free, voluntary value-based payment model in oncology will soon give way to a bilateral risk model. And while entering bilateral risk now may not be right for all practices right away, ignoring the tectonic shift in pay carries danger. Practices must understand value-based models through their implementation so that their patients can benefit from better coordination of care, medication utilization, and communication between the care team and their patients outside of the clinic.