2014 Proceedings - Genentech Forum

ADVANCING CANCER
CARE IN A NEW ERA
CONFERENCE
PROCEEDINGS
MCM/020315/0049
ADVANCING CANCER CARE IN A NEW ERA
PROGRAM SUMMARY
THE GENENTECH ONCOLOGY INSTITUTE: ADVANCING CANCER CARE IN A NEW ERA
Participants
The conference drew over 90 managed market executives from across the US, including representatives from
national and regional health plans, large employers, hospital systems, distributors, specialty pharmacy, and
academic institutions, among others.
The Genentech Oncology Institute hosted its third interactive
forum on May 1st and 2nd, 2014, at Genentech’s corporate
campus in South San Francisco, California. The event
provided an opportunity for healthcare stakeholders,
including managed market executives and Genentech,
to discuss and learn about the crucial issues related to
the future of cancer care in the United States.
Distribution of Participants by Type of Organization
This year’s program focused on emerging technologies and
innovations in oncology. Topics spanned the full spectrum of
patient care, from molecular diagnostics and personalized medicine
to improved care delivery models and survivorship issues.
2%
11%
11%
Distributors
Employers
10%
91
Attendees
"If you want to innovate, you can't call what you're doing
innovation unless you do every one of the following things:
improve survival, improve quality of life, diminish side
effects, and make it worth it... It's got to be clinically
significant, because that's going to matter to patients."
— Dr. Clifford Goodman
17%
Program moderator, Clifford Goodman, PhD, Senior
Vice President and Principal, The Lewin Group,
opening the meeting.
Faculty
Mara Aspinall, MBA, Ventana Medical Systems
Sean Bohen, MD, PhD, Genentech, Inc.
Linda D. Bosserman, MD, FACP, Wilshire Oncology
William S. Dalton, PhD, MD, Moffitt Cancer Center
Anne Boland Docimo, MD, MBA, UPMC Health Plan
and Hospitals
Ezekiel Emanuel, MD, PhD, University of Pennsylvania
Laura Esserman, MD, MBA, Carol Franc Buck Breast
Care Center, UCSF
Barry Fortner, PhD, ION Solutions
Clifford Goodman, PhD, The Lewin Group
Michael A. Kolodziej, MD, FACP, Aetna
Jack Mahoney, MD, MPH, Florida Health Care Coalition
Jennifer Malin, MD, PhD, WellPoint
Lee Newcomer, MD, MHA, UnitedHealthcare
R. Steven Paulson, MD, Texas Oncology
James C. Robinson, PhD, MPH, University of
California at Berkeley
Lillian D. Shockney, RN, BS, MAS, Johns Hopkins
Breast Center
Eric Topol, MD, Scripps Translational Science Institute
Marc L. Watrous, PhD, Genentech, Inc.
Lu Zawistowich, ScD, Patton Boggs, LLP
24%
Hospitals, Health Systems
and Providers
National/Regional Payers
Other
Pathway Managers
12%
13%
PBMs
“In order to move forward in
this field, we have to get this
‘tear-the-wall-down’ philosophy
and this whole idea that we’re all
going to be smarter if we work
together. That’s the only chance I
see of really escalating success in
the treatment of cancer.”
— Dr. Eric Topol
Specialty Pharmacies
Geographic Distribution of Participants
Faculty
Attendees
The mission of the Genentech Oncology Institute is to engage health care stakeholders
in the challenges they will face in the future management of cancer care through an
exchange of information and forward-looking visions.
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ADVANCING CANCER CARE IN A NEW ERA
PROGRAM SUMMARY
PROGRAM SUMMARY
DAY TWO: The Future of Cancer Care with a Patient Focus
The 2014 conference spanned six main themes, all of which are critical aspects of oncology care today
and in the future.
The second day moved from the high-level trends and technologies in oncology to examining the impact of these
innovations on improved patient care. Many of the conversations centered around the balance of incorporating
new innovations while keeping the needs of the patient front and center.
DAY 1:
Key Trends in
Cancer Care
DAY 2:
The Future of
Cancer Care with
a Patient Focus
The Current State of Cancer Care
Innovations in Personalized Medicine and Molecular Diagnostics
Future Technologies and their Impact on Cancer Care Delivery
Lillian Shockney, a two-time breast cancer survivor and nurse, opened with a powerful account of her personal
journey through diagnosis and treatment. Her presentation on The Patient Perspective of Cancer Survivorship looked
at improving the patient experience and quality of life through care coordination, education, greater transparency
of care options, and understanding patient desires. A second panel, moderated by Dr. Clifford Goodman, followed,
focusing on the challenges and opportunities around Reconciling Patient Outcomes and Affordability. The
discussion highlighted the preferred state of comprehensive cancer care and the gaps in today’s care delivery
models. Looking towards the future, the panel explored collaborative solutions for enhancing patients’ quality of life
before, during and after treatment.
The event closed with a call to action for the healthcare industry through a panel focused on the strategies for
Preparing for Cancer Care in 2020. A series of video vignettes depicting four possible scenarios for cancer care
brought into focus the varied perspectives and interests of the different stakeholders. Moderated by Dr. Goodman, the
panel examined the current trends and strategized ways for stakeholders to work together in preparing for the new era.
The Patient Perspective of Cancer Survivorship
Reconciling Patient Outcomes and Affordability
Preparing for Cancer Care in 2020
DAY ONE: Key Trends in Cancer Care
Dr. Ezekiel Emanuel kicked off the conference with a powerful account of The Current State of Cancer Care.
He spoke to the nearly $3 trillion currently spent for health care, which includes significant unnecessary
expenditures. He analyzed the impact of the Affordable Care Act and highlighted some of the megatrends that
will drive future changes in the American healthcare system.
Furthering the conversation around the need to eliminate excess
costs, Dr. Sean Bohen and Mara Aspinall explored Innovations
in Personalized Medicine and Molecular Diagnostics. Dr. Bohen
addressed how identification of biomarkers and other recent
advances are allowing physicians to tailor cancer treatments
to individual patients. Aspinall described the expanding role of
molecular diagnostics in disease diagnosis and the future promise
these methods offer across the entire spectrum of cancer care,
including potential new therapies.
Next, Dr. Eric Topol took the audience on a thought-provoking tour
of Future Technologies and Their Impact on Cancer Care Delivery.
He addressed the ability of genomics, wireless sensors, and other
new technologies to personalize prevention and drug treatment.
While innovation and technological applications offer new cancer
diagnostic and treatment approaches, significant challenges must
be overcome to bring these advances into the clinical setting.
Moderator Dr. James C. Robinson invited perspectives from a panel
of oncology providers, who discussed the feasibility and practicality
of applying scientific and technological innovations to standard
practice, evaluating the associated benefits and costs.
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“What we’re trying to do is figure out
how we can change the processes
of care delivery so that we can take
advantage of the knowledge we do have
and do it very well, carve out the things
that aren’t working, and free up some
money to start doing 2020 projects.”
— Dr. Lee Newcomer
"Our hope from today is that somehow you integrate the good news, the challenge of the costs, and the
evolving delivery of the care. We can try to collectively go forward here and do the right thing for patients,
but do it in a manner which is affordable to society."
— Ian Clark
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ADVANCING CANCER CARE IN A NEW ERA
THE CURRENT STATE OF CANCER CARE
Ezekiel Emanuel, MD, opened the conference with a provocative keynote speech that highlighted how
impending changes in the American healthcare system will drive transformations in cancer care to a more
integrated model versus today's fragmented care delivery structure.
Healthcare Spending in America is Unsustainable
Dr. Emanuel’s presentation began with a look at the staggering gap between the US and other nations in
healthcare spending after adjusting for relative wealth. The United States healthcare system, which spends
$2.97 trillion annually, is now the fifth largest economy in the world. At current growth rates, healthcare
spending out paces inflation and is unsustainable. A deeper dive into healthcare spending reveals that 10%
of the population (including cancer patients) account for two thirds of healthcare spending.
These integrated systems will be incentivized to
reduce unnecessary spending and be more efficient
in care delivery. Three areas of potential savings in
cancer care include:
Reducing variability and waste
“No one would say we don’t have
enough money in the health care
system…The issue is how we spend it
and how we think about spending it.”
Integrated delivery systems will encourage
standardization of treatment and prioritization
of cost-effective testing and treatment. Specific
opportunities are to:
— Dr. Ezekiel Emanuel
•
Reduce unnecessary testing and imaging
through greater adherence to NCCN, ASCO,
or payer-specific clinical guidelines.
High Healthcare Costs are Driven by Provider Services and Patients with Chronic Conditions
•
Next, Dr. Emanuel answered the question, "Where does the money go?" by breaking down healthcare spending.
He dispelled a commonly held public opinion that drug and insurance companies are the greatest spenders
of healthcare and highlighted that hospitals spend approximately $1 trillion per year. This is nearly double what
is spent on drugs annually.
Develop oncology-specific electronic
medical records (EMRs) to track testing, imaging, and guideline adherence.
•
Limit use of radiation therapy and proton beam therapy without proof of added benefit.
Patients with chronic conditions, including cancer, are accountable for 84% of spending. He emphasized the
importance of improving quality and reducing costs for those patients.
Megatrends in American Healthcare Will Transform Cancer Care
After providing a fairly bleak picture of America’s current healthcare system, Dr. Emanuel addressed
opportunities for stakeholders to transform healthcare amid reforms introduced with the Affordable Care Act.
SIX MEGATRENDS IN HEALTHCARE
By 2020
• VIP care for the chronically & mentally ill
• The emergence of digital medicine and
closure of hospitals
• End of healthcare inflation
By 2025
• End of insurance companies as we know them
• End of employer-sponsored health insurance
• Transformation of medical education
In concluding his book, Reinventing American Healthcare, Dr. Emanuel made six bold
predictions about the radical changes we can expect in the next 10 years.
Key among Dr. Emanuel’s recommendations is that insurance companies will need to reinvent themselves to survive.
He envisions the growth of large integrated delivery systems, which provide care across the continuum from prevention
to end-of-life care, combining the provider and insurance functions.
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KEY TRENDS IN CANCER CARE
THE CURRENT STATE OF CANCER CARE
Leveraging VIP care to keep patients out of the emergency room and hospital
Adopt a coordinated, team-based approach for chronically ill patients to prevent avoidable ER visits
and hospitalizations.
The main components of VIP care are:
•
Team-based care delivery with increased reliance on patient navigators and non-physician practitioners.
•
24/7 access to providers, telephone/webcam triage, and additional house call and in-home hospital care.
•
Proactive symptom management, including additional psychosocial services.
Transforming end-of-life care
While acknowledging the improvements in existing end-of-life care practices,
Dr. Emanuel emphasized the persisting challenges in this area, highlighting that
50% of cancer patients are hospitalized in the last 30 days of life. He urged all
stakeholders, including oncologists and educators, to:
•
Enhance end-of-life communication including beginning conversation
about goals of care and palliative care options earlier.
•
Improve symptom management and psychosocial care capabilities.
•
Reduce use of third- and fourth-line chemotherapies in metastatic disease.
•
Decrease ICU and the number of hospital days in the last 30 days of life.
•
Increase length of hospice stay when appropriate.
“Hospitals, which have long
been a profit center, will
become a cost center. A lot
[will be] invested in keeping
patients out of the hospital
and healthy.”
— Dr. Ezekiel Emanuel
Dr. Emanuel’s personal predictions on how healthcare megatrends will impact cancer stakeholders prompted many
more questions that guided later conversations in the conference. These topics included how to change entrenched,
systemic problems that drive up costs and how to redefine innovations and determine their value.
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KEY TRENDS IN CANCER CARE
INNOVATIONS IN PERSONALIZED MEDICINE
AND MOLECULAR DIAGNOSTICS
ADVANCING CANCER CARE IN A NEW ERA
INNOVATIONS IN PERSONALIZED MEDICINE AND MOLECULAR DIAGNOSTICS
Diagnostic Tests Are Undervalued
Faced with unsustainable costs, the US healthcare system needs effective tools to support the increasingly
individualized approaches to patient care. Genentech’s Sean Bohen, MD, PhD, and Ventana’s Mara Aspinall,
MBA, provided an inside look at how breakthroughs in personalized medicine and molecular diagnostics have the
potential to be these tools.
Despite the progress they have already made in terms of reducing costs and improving patient care,
diagnostics remain undervalued. Common perception maintains a narrow view of what these technologies can
do, although Aspinall and others assert diagnostics are powerful and useful for decision makers across the
health care spectrum.
•
Studies suggest that the 2% of provider
spend on diagnostics impacts 60% of decision
making. (The Lewin Group, Inc. The Value
of Diagnostics: Innovation, Adoption and
Diffusion into Health Care. July, 2005)
•
Diagnostics can be applied across the
spectrum of care, from screening and subtyping disease to treatment and monitoring.
•
Diagnostics can be used to rule out expensive,
unnecessary, and inefficient therapies.
Personalized Medicine Aims to Eliminate
“One-Size-Fits-All” Cancer Care
The focus of cancer care delivery is moving away from
a one-size-fits-all approach towards one that tailors
treatments to individual patients and the unique
molecular profiles of their tumor tissue.
Traditionally, cancer treatments have been based on
treating the disease rather than personal and genetic
variations of patients, which has led to unnecessary
toxicity and ineffective therapy.
Biomarkers offer enhanced cancer detection and great
promise in the drug development process, from research
and early clinical trials through clinical practice.
•
Novel technologies are enabling biomarker
assessment in limited tissue and next-generation
diagnostics.
•
Biomarkers can help identify drug targets to guide
selection of optimal treatments.
These tools and technologies not
only impact the oncologists, but also
surgeons, pathologists, radiologists,
and other specialists. The potential of
personalized medicine is predicated
in large part on expanding patient
access to diagnostic testing. Calling
diagnostics “the decision maker” of the
future, Aspinall discussed how these
technologies have begun to impact
cancer treatment by enabling targeted
therapies to focus on specific patients
and identifying risk information
through genomic screening.
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— Mara Aspinall
Personalized Health Care Adds Value to
Diagnostics
Personalized medicine can be used for understanding
the underlying disease pathology and guiding the
treatment paradigm for each patient.
Biomarkers Are Key to Personalized Medicine
“Diagnostics is not
actually just for diagnosis
any more. It’s for every
part of the healthcare
spectrum.”
“What we’re trying to do with
personalized health care is characterize
that diversity and then turn that diversity
into treatment decisions that give the
patients better outcomes.”
— Dr. Sean Bohen
The value proposition of diagnostic testing improves
when considering the many applications they have
in personalized medicine. Diagnostic testing can
help with:
•
Selecting appropriate drugs and
determining dosing.
•
Improving efficacy and predicting resistance.
•
Monitoring/disease status.
•
Assessing recurrent risk.
New Approaches Are Needed for Clinical Trials, Research, and Professional Training
Personalized Healthcare
Dr. Bohen and Mara Aspinall each explored the strategic approaches necessary for the advancement of personalized
medicine and diagnostics.
•
•
To combat inefficient therapy and unnecessary toxicity, Personalized
Healthcare aims to individualize treatment to the appropriate patient
subgroups and the characteristics of their underlying disease.
•
Biomarker development in oncology has yielded new approaches to
designing clinical trials, where the diagnostic and therapeutic hypotheses
are considered simultaneously in early development and lead to
development of companion diagnostics.
Increased efficacy in personalized therapy will require pivotal trials in
smaller subsets to prove effectiveness; this will require screening large
numbers of patients to identify the potentially small patient group that
will respond to treatment.
"Diagnostics is really an
information business with
a wet lab on the side. It
is nothing if you don’t
have confidence in the
information that comes out."
— Mara Aspinall
A paradigm shift for how disease is diagnosed and how to treat each
patient based on breakthrough biomarkers will be required as cancer care
providers adapt to personalized health care.
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KEY TRENDS IN CANCER CARE
FUTURE TECHNOLOGIES AND THERE IMPACT
ON CANCER CARE DELIVERY
ADVANCING CANCER CARE IN A NEW ERA
FUTURE TECHNOLOGIES AND THEIR IMPACT ON CANCER CARE DELIVERY
Genomic Technologies Allow For Individualized Treatment Selection
Following the topics of personalized medicine and molecular diagnostics, Eric Topol, MD, took the conversation
to the next level in his dynamic keynote, which highlighted breakthrough technologies that have the potential to
dramatically transform care delivery. Dr. Topol described this time in medicine as “exceptionally exciting” and
reviewed examples of innovations designed to improve patient outcomes, increase efficiency, and create a more
personalized approach to cancer care.
Expanding upon the earlier conversation on personalized medicine, Dr. Topol described new genome-based
technologies that improve diagnosis and patient characterization in order to identify the best therapy for each patient.
New Technology “Digitizes” Human
Beings to Diagnose Cancer
Capturing constant and live data of individuals,
sensor-based technology may help detect cancer
earlier than current methods. Examples include:
•
Sensors woven into the fabric of a bra to
pick up subtle metabolic changes associated
with breast cancer tumor formation.
•
Sensors that mimic the biological
olfactory mechanisms that allow dogs
to “smell” cancer.
•
Breath sensor devices that
continuously monitor for changes
associated with oral cancers.
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•
Liquid biopsy, a blood-based detection of biomarkers, offers an easily obtainable, minimally invasive
view of a patient’s individual tumor. Still in its early stages of development, the technique demonstrates
the high sensitivity of positron emission tomography (PET) without the radiation exposure. This may
offer a safe, accurate and cost-effective alternative screening method for cancer.
•
Open-access, online genetic databases are designed to collect DNA samples from patients with acute
myeloid leukemia (AML) and other rare and hard-to-treat diseases. Through a collaboration between
academia and industry, the material can be analyzed for certain genetic mutations and used to study
potential treatments.
Dr. Topol spoke to the increased access to information that patients now have at their fingertips, allowing them
to take a more active role in their treatment decisions. He highlighted the importance of optimal sharing and
utilization of this data to improve outcomes both from a patient and provider perspective. An example of an
innovative tool that is currently available is "Ask Watson," which can be used to guide clinical decisions.
Dr. Eric Topol provided a fascinating look at how canine cancer detectors
and other new technologies are reshaping the future of medicine.
•
Dr. Topol’s study using nanosensors and genomic sensors, embedded in the blood vessels, to monitor a
patient’s heart attack risk.
•
Sensors that can be used to detect
autoimmune attacks like multiple
sclerosis, diabetes, and rheumatoid
arthritis; and even cancer. In the
future, embedded nanosensors
could replace PET scans by
providing patients previously
treated for cancer with
continuous surveillance.
— Dr. Eric Topol
Whole-exome sequencing of single circulating tumor cells (CTCs) provides a highly sensitive analysis
that can be used to understand the underlying genomics of the cancer.
Increased Access to Information Empowers Both Patients and Providers
Current research points toward new ways to monitor disease, suggesting that the future of sensor-based technology
lies within the body. Examples include:
"I’ve been talking about lab on a chip,
but now I want to move to a really
exciting area, which I think is going to
have a significant impact in the future;
and that is lab in the body."
•
Real-World Barriers to Implementation Include Lack of
Integration and Cost Implications
Several multi-stakeholder panels addressed the challenges they see in
implementing these innovations in their own organizations.
•
William Dalton, MD, discussed the current challenges to
using data, including the lack of integration within the
healthcare system. He stated that health care data and
information will only be meaningful when incorporated into
standards of care to demonstrate improved outcomes.
•
Linda Bosserman, MD, addressed the productivity and cost
implications of implementing new technology. She provided,
as an example, the challenges her organization faced in
implementing an oncology medical records system, specifically
around data entry and analytics: “We don’t have an optimum
way to do that, and it’s very expensive.” She also expressed
concern about the financial burden to patients, who are already
struggling to meet the basic costs of cancer care. She said
that while opportunities exist to deliver care more efficiently
through advances in technology, we must address misaligned
incentives, fragmented systems and other barriers in order to
take full advantage of these innovations.
FUTURE = "LAB IN THE BODY"
Car
400+
on-board sensors
Smartphone
>10 embedded
sensors + 4 radios
Human
0 sensors
Your car and cell phone both utilize sensors to notify and monitor
performance. Researchers are now designing nanosensors, embedded within
the body, that will enable similar continuous surveillance in humans.
•
"We’re generating an enormous
amount of data that is not
harmonized, it’s not integrated, and
we don’t know how to present it."
— Dr. William Dalton
Steven Paulson, MD, described the relationship his organization formed with the National Comprehensive
Cancer Network (NCCN) to create pathways that are consensus and clinical data driven. An existing
challenge is that many physicians have not openly embraced the pathway model. With time, many have
come to trust that the model is evidence-based, and patient-centric, leading to increased acceptance and
exploration of pathways.
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ADVANCING CANCER CARE IN A NEW ERA
THE FUTURE OF CANCER CARE WITH A PATIENT FOCUS
THE PATIENT PERSPECTIVE OF CANCER SURVIVORSHIP
Collaboration Among All Stakeholders is the Key to Successful Implementation
THE PATIENT PERSPECTIVE OF CANCER SURVIVORSHIP
Acknowledging these many challenges that exist in healthcare today, the panel focused on how to resolve
these challenges and move healthcare forward into the future. Lee Newcomer, MD, emphasized the importance of
all-stakeholder collaboration in changing the processes of care delivery so that everyone can take advantage of the
current knowledge and technologies. The panelists identified key areas in which stakeholders can work together to
create a system that rewards innovation and delivers effective, efficient, and patient-centered cancer care.
Lillian Shockney, RN, opened Day 2 with a powerful keynote address that highlighted her experiences with breast
cancer both as a patient and provider. Shockney described her personal experiences in battling cancer and how they
have shaped the work she has done to enhance patient care for other women diagnosed with the disease.
•
Test cancer care process innovations in pilot programs in order to generate evidence and share information
that inspires adoption on a national scale. True change will require regional and national commitments, not
just localized initiatives.
•
Promote multidisciplinary alliances that can share and validate data, repositories, and tissue
samples. Once validated, the findings can be used in the community and delivered to points of care.
•
Emphasize flexibility in patient care options. A suggestion was discussed to develop a pathway where the
first- and second-line treatment options are patient-selected chemotherapy, but the third-line treatment
option is a clinical trial or end-of-life discussion; or the patient takes on financial risk. This would help
to change the way physicians think and the way they talk to patients.
•
Bring together providers, manufacturers, and even competitors to create innovation alliances.
Each stakeholder must be held to outcome accountability, sharing the risk and developing collaborative
solutions.
Providers Can Empower Patients to Have an Active Voice in Their Care
Shockney identified strategies for health professionals to engage
patients in their own care, including providing access to
specialists skilled in treating the patient’s particular type of
cancer. She also stressed the importance of communicating
options and outcomes (beyond survival rates) and providing
information on clinical trials and their associated value.
Patients and Families Need Support Throughout the
Disease Progression
Psychological, social, emotional and practical support for all
impacted by the cancer diagnosis are integral components of
cancer care. Shockney stressed the importance of providers
being honest and providing realistic expectations to patients
while still conveying optimism. Specific support cancer patients
may need includes:
•
Encouragement to focus on quality of life.
•
Increased transparency around intimacy and changes
post cancer.
•
Ongoing conversations regarding treatment and life goals.
•
Support for end-of-life planning, including emotional,
physical, spiritual, financial, and legal.
“Quality of life is far more important
to our patients than being on the
survivor chart for living an extra
three weeks or a month.”
— Lillian Shockney
Cancer Survivorship Care Requires Commitment from the Healthcare Community and Employers
Shockney identified strategies specific to building capabilities among providers to assist cancer survivors as they
transition from treatment to recovery and improve overall quality of life.
Panelists discuss the challenges of incorporating innovation into oncology practice. From left to right:
Dr. Lee Newcomer, Dr. William Dalton, Dr. Linda Bosserman, Dr. Steven Paulson and Dr. Jamie Robinson.
"The pathways are based first on efficacy and second on toxicity, but it’s also about incorporating financial
information into the equation. The ability to have that information, and to react to it, has been a useful
step towards relationships with payers with regards to managing costs."
— Dr. Steven Paulson
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•
Develop incentives for medical students to become oncologists in order to address the growing shortage.
•
Increase communication training and patient interaction training for cancer providers, as having
conversations about treatment and care options early is central to effective cancer care.
•
Educate internal medicine physicians on the challenges of the transition to cancer survivorship to ensure
long-term patient support.
•
Include a financial counselor on the oncology team to address treatment-related costs and concerns.
•
Integrate palliative care practices into ongoing care delivery.
Shockney also shared best practices that employers can implement, as 40% of individuals diagnosed
with cancer are under the age of 65 and are working full time:
•
Provide employment-related education and support resources specifically around survivorship.
•
Promote cancer awareness in the workplace with prevention and early detection information
and resources (e.g., offer free screenings during lunch).
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ADVANCING CANCER CARE IN A NEW ERA
THE FUTURE OF CANCER CARE WITH A PATIENT FOCUS
RECONCILING PATIENT OUTCOMES AND AFFORDABILITY
RECONCILING PATIENT OUTCOMES AND AFFORDABILITY
Assessment of Patient Needs is Required and Should Be Measured Along with Outcomes
Schockney laid out the essential components of care for patients throughout the patient journey. The panel
discussion that followed explored how these practices can be implemented within current care delivery
models, while balancing the key objectives of improved outcomes and affordable costs. Gaps between ideal
comprehensive cancer care and existing models were first identified and then the panel explored collaborative
solutions for enhancing the patient experience.
Beyond bringing together the patient, provider and payer in new ways like many of the emerging integrated
delivery networks, the panel explored additional opportunities to improve patient care with an increased
emphasis on better understanding and acting upon patient needs.
•
Barry Fortner, PhD, emphasized that patients, in "short order," are going to have access to more
sophisticated information about treatments. This will result in more informed questions and require
health care providers to be well prepared to have discussions regarding prognosis and treatment
choices. Additionally, providers must be willing and flexible enough to integrate the needs and wants
of a cancer patient in their care plan. Providers should be open to hearing that some of their patients
may not wish to extend life at the price of lower quality of life.
•
Dr. Kolodziej commented that fundamentally, patient-centered care is low-tech and hi-touch. “It’s
holding hands. It’s being honest,” he said.
“We just love technology because it’s
technology. But if it does not improve the
patient experience, the patient outcome,
it isn’t really worth anything.” He went
on to say that “we’re at a point where
we just have to measure what people
do. What’s a surrogate measurement for
delivering a good patient experience?... Is
it days on hospice, for example? Or, is it
involvement of palliative care, and how do
we measure that?... I think we all have to be
comfortable with the idea that we’re going
to be measured.”
•
Dr. Bosserman further emphasized the
importance of using technology solutions
to keep the patient at the forefront. For
“Our patients are having trouble co-paying just
example, her organization implemented
the basics of cancer, and so when we bring in
innovative things, how we bring it in, the financial
the Patient Portal, a website that offers
burdens to patients, are tremendous.”
providers 24-hour access to electronic
health records. The tool is designed to
— Dr. Linda Bosserman
enhance patient-provider communication
and empower patients with more
information about their care plan.
Dr. Bosserman stressed better survey instruments and data collection tools are needed to accurately
reflect the impact of the disease on quality of life and other patient-related factors.
Costs Are Important in Assessing Care Delivery Models
Panelists discussed care delivery models that are currently being employed or piloted to address the need
for improved care and outcomes at moderate costs.
•
Linda Bosserman, MD, described her organization’s medical oncology home model as a way to
provide comprehensive, patient-centered care with improved outcomes while controlling costs.
She grouped the key cost drivers into five categories: therapies, supportive care, emergency room
visits, hospitalizations, and end-of-life care. Critical elements of this particular medical oncology
home model include enhanced care coordination and management, with monthly clinical meetings
in which providers discuss pathways and review new patient cases.
•
In response to a question raised regarding appropriate management of high-priced cancer drugs,
Michael Kolodziej, MD, asserted that it is both the payer’s and provider’s responsibility to assess
the relative value of these
expensive treatments to
the patient returning to
the frequently discussed
theme of all stakeholders
working together.
•
Dr. Kolodziej also noted
that the payer community
is an important stakeholder
in this conversation. He
emphasized that health
plans, physicians and
government entities must
work collaboratively keeping
the focus on the patient.
According to Dr. Kolodziej,
“Everything has to be
viewed through the prism
of how it is going to
improve patient outcomes.”
“We need to stop thinking of the health plan as an
impediment and look at the health plan as potentially
being part of the solution.”
— Dr. Michael Kolodziej
"We should not minimize the significance of improving quality. In fact, that should be our ultimate aim... If
we make it all about money, it will be very difficult to innovate."
— Dr. Michael Kolodziej
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ADVANCING CANCER CARE IN A NEW ERA
THE FUTURE OF CANCER CARE WITH A PATIENT FOCUS
PREPARING FOR CANCER CARE IN 2020
PREPARING FOR CANCER CARE IN 2020
The state of cancer care is in flux. Given the ongoing changes, the last session of the meeting asked
participants to explore potential scenarios for the state of cancer care in 2020. Panelists and audience
members viewed a series of brief video vignettes that brought to life ongoing health care trends and resulted
in four distinct future states. The discussion addressed changes in the industry that could drive each of the
future scenarios and explored the potential roles and responsibilities of their respective organizations.
Participants also received the “2020 Scenario Roadmap,” a decision-making tool designed to help
stakeholders better understand the factors influencing these futures and prepare for the challenges and
opportunities that lie ahead. Based on research by scenario planning experts and key industry leaders, the
roadmap also incorporated results from the Stakeholder Survey, a previously administered questionnaire on
the perceived impact of trends and uncertainties on the future of cancer care.
In this scenario, strong economic growth for several years has prolonged a nonintegrated healthcare system, impacting both payment and delivery models. Reform
legislation created a steady increase of Americans with healthcare coverage of some
variety; however, efforts to contain medical costs have been modest. As a result,
the average cost of care per cancer patient in 2020 is higher than ever. Despite
management efforts, the percentage of GDP spent on
healthcare is currently at 20%. Agreement is widespread
that more dramatic measures are needed to reduce
spending. Due to the robust economy, R&D investments
to pursue scientific breakthroughs in cancer treatment
remain high, but promising early stage programs have
failed to deliver.
In this 2020 environment, average spending per cancer patient has been modestly
reduced and there is continued pressure for greater healthcare delivery integration.
A sluggish economy spurs a renewed mandate for cost control under a governmentfunded healthcare system, resulting in frustration among some providers. At the same
time, meager private and public research funding have held up the discovery of both
technology-related and therapy-based innovations. While
there is some provider and insurer data integration,
useful health information technology becomes a virtual
dream deferred. As a result of disappointing corporate
R&D outcomes plus reduced government funding,
cancer research fails to deliver the kind of advances
once considered within arms’ reach.
SCENARIO #2: BULL IN A CHINA SHOP
SCENARIO #4: BIG DATA DELIVERS
In 2020, a cycle of strong GDP growth is in full swing. The strong economy supports
the interests of entrenched healthcare stakeholders, and the overall delivery of care
remains non-integrated. While the ACA is still in effect, pressures to rein in feefor-service demands are muted due to the greater economic prosperity. As the cost
of care increases, employers continue to shift the financial burden to employees.
Several significant R&D breakthroughs suggest that the
tide in treating cancer will also turn. While many are still
experimental, such developments are good news for the
treatment of patients diagnosed with cancer. However,
in this non-integrated environment of cancer care, there
is inadequate coordination and inefficiencies within the
delivery system as a whole that have yet to be addressed.
In this version of the future, the healthcare system delivers expansive medical
breakthroughs. In 2020, the economy continues its modest growth. Big-data analytics
and integration of advanced technologies fuel scientific advances across highly
coordinated centers of cancer research and care. Both public and commercial payers
have begun to establish interoperable EMR interchanges with providers. Advances
in health information technologies help to develop new treatment guidelines based
on findings from CER studies. With these innovations,
however, new challenges in care delivery emerge. Patient
care is compromised due to delays within these emerging
integrated systems. Though provider competition initially
eases up – with the media hailing 2020 as “The Year of
Collaboration” — salaried oncologists are criticized for
providing less service less often.
NON-INTEGRATED
INTEGRATED
Care Delivery Model
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Cancer Care Innovation
SCENARIO #3: RISKY BUSINESS AS USUAL
INCREMENTAL
SCENERIO #1: HOPE AT ANY COST
DISRUPTIVE
DISRUPTIVE
Cancer Care Innovation
INCREMENTAL
Exploring the Future of US Cancer Care in 2020
Care Delivery Model
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ADVANCING CANCER CARE IN A NEW ERA
THE FUTURE OF CANCER CARE WITH A PATIENT FOCUS
PREPARING FOR CANCER CARE IN 2020
An Integrated Delivery System with Disruptive Innovation Was Selected as the Ideal Future
The Future Hinges on Acceptance of Risk and a Shared Commitment to Improve Care
When polled, 78% of the panel and audience identified “Big Data
Delivers,” an integrated delivery system with breakthrough technologies,
as their preferred future. They agreed that this would be the most
desirable scenario for patients as well as all other stakeholder groups.
The audience advocated that a future where there is more access to
data has the potential to create significant value in cancer care through
development of individual treatment plans that will work best for each
cancer patient. Additionally, big data can be used to identify sources of
waste in the healthcare system and help lower costs across the spectrum
of care.
In bringing the event to a conclusion, panelists were asked how would they bring the conversations to practice.
They each identified one action that must take place to achieve the preferred future scenario.
However to achieve this future scenario, there are significant
challenges that must be addressed including:
•
Effectively incorporating big data and next-generation
analytics into clinical practice.
•
Helping patients navigate an increasingly complex and
data-driven healthcare system.
•
Providing for elderly, low-income and other patient populations
who may not have access to healthcare-related computer
applications and other emerging decision-support tools.
Most Preferred Future for
Cancer Care in the Year 2020
(Results of Audience Poll)
100%
75%
5%
11%
18%
Risky Business
Jack Mahoney, MD, advocated for stakeholders to “step away from our vested interests and look at
what is the greater goal. What is the outcome that we need?”
•
Lu Zawistowich, ScD, said we need “key stakeholders at the table with a willingness to take risk and
experiment around different care models.”
•
Laura Esserman, MD, said that the future hinges on a comprehensive collaboration plan that brings all
stakeholders together so that “everyone’s got skin in the game.” With this kind of collaboration, there
can be successful data collection and interpretation and determination of new models of care.
Hope at Any Cost
50%
78%
25%
•
Bull in a China Shop
Big Data Delivers
0%
An Optimal Future Scenario Hinges Upon Successful Collection and Integration of Health Care Data
The audience discussion identified steps that would help move us toward the “Big Data” future. The importance
of aligning incentives to support data collection, promote collaboration, and advance evidence-based shared
decision making were emphasized. The discussion also called for all costs of cancer to be accounted for in the
data collection process. For example, employer-related data such as absenteeism, disability time and time away
from work also needs to be collected, as often these costs may exceed the actual costs of the direct treatment.
The audience also emphasized that big data needs to be actionable
and provide meaningful insight and comprehensible information to
Somewhere in the designing of all these
drive innovation.
tools to better manage health care, we've
One of the most important success factors in the use of big data in
somehow forgotten the patient."
health care is the effective implementation of EMRs. Stakeholders
emphasized the need for an integrated medical records system that
— Dr. Lu Zawistowich
is in place across all sites of care. Information entry in these EMRs
needs to be standardized in terms of content and format to ensure
consistency.
"You've got to have valuebased systems. You have to
align incentives in different
ways so that people are
paid for taking the time
to collect this kind of
information [big data],
have the conversations
with patients, and take
some risk."
— Dr. Laura Esserman
Dr. Goodman presents the “2020 Scenario Road Map,”
a decision-making tool designed to help stakeholders
anticipate changes and prepare for opportunities in US
cancer care over the next six years. Successful Innovation Needs to be Balanced with Value to the Patient
While a future with disruptive technologies and innovations was viewed to be the desired state, the stakeholders
discussed that this would only be meaningful if they aligned with the needs of the patient. Patients must be
able to access this information and truly understand what it means for their care. Marc Watrous, PhD, indicated
that he thought manufacturers would have to use a new standard for developing innovation based on what really
matters. “We all have to agree what is ‘clinically meaningful’ and what ‘value’ really means.”
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Panelists explored four future scenarios of the state of cancer care in the year 2020. They brought viewpoints from the
provider, employer, payer, manufacturer, and public sector. From left to right: Dr. Laura Esserman, Dr. Jack Mahoney,
Dr. Jennifer Malin, Dr. Marc Watrous, Dr. Lu Zawistowich, and Dr. Clifford Goodman.
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outcomes
Cancer
technology
breakthroughs
risk
practice
Innovate
medicine
testing
approaches
data
diagnosis
medicine
treatment
use
clinical
challenges
potential
tumor
advances
powerful
Therapies
needs
integration
molecular advances
survivorship
state
meaningful
access
costs
testing
management
spectrum
Healthcare
improve
Patient
new
focus
Biomarker
life
© 2014 Genentech, Inc., So. San Francisco, CA 12/2014