Why Oncology Can Be a Tough Sell in Maine

OncLive Chairman,

Mike Hennessy

Chimeric antigen receptor (CAR) T-cell therapy may soon hit the market, and numerous cancer care centers are poised to offer this for what may be the first FDA-approved indication: relapsed/refractory B-cell acute lymphoblastic leukemia. The promise of CAR T cells along with the potentially severe adverse events (AEs) have been well documented. One of those AEs may be financial toxicity. Consider a potential price tag as high as $700,000! Advocates argue that the ability to give the gift of a cancer-free life to a child or young adult may well be worth the money.

Ensuring access for patients on Medicaid is no easy matter. Consider the challenges faced by cancer centers that helped to develop a lung cancer model of care just launched by the Association for Community Cancer Centers (ACCC). In Maine, an entrenched attitude among residents that "I’m going to die of something anyway" made it difficult to get patients to follow through with recommendations for care. In Florida, patients often were lost to follow-up efforts because of the lack of reliable contact information. In Louisiana, oncologists found that a bottleneck to access occurred with primary care physicians who failed to make referrals.

The innovative solutions from this group of practices helped to form a template for the Optimal Care Coordination Model from the ACCC, which is now entering beta testing, according to Randall Oyer, MD, co-principal investigator and co-chair of the project advisory committee.

Improving practice operations is a strong theme in this month’s issue of Oncology Business Management^TM. Two years ago, John Sprandio, MD, of Consultants in Medical Oncology and Hematology of Philadelphia, was asked by Capital BlueCross to help establish a patient-centered medical home model in 4 member practices. This year, the first batch of performance data emerged, showing strong reductions in emergency department (ED) visits and hospital admissions. Also, Capital BlueCross paid physicians incentives for the achievements but still managed to save money. Measures of care quality did not improve as much as hoped, but Capital and the participating practices are counting on the next round of data to show progress there, as well.

Arizona Oncology, in the lower half of the state, is an independent group of practices that had the opportunity to build a completely modern facility from the ground up. They usually rent their offices, which limits their ability to have things the way they want, but this time they worked with the architects directly to design the shell of their building and arrange for all other details, as well. The result: a facility with high-volume services near the entrance to minimize walking for patients and sta members. They put more nurse stations in the infusion center, also to improve efficiency, and installed a modern radiation center that does not require the heavy shielding typical of older designs, thus enabling them to position this area closer to the center of operations and further reduce walking time. They even installed cooling waterfalls to create a refreshing sense of peace, something patients likely will appreciate as Arizona’s temperatures continue to soar.