Lindsay Conway, a managing director of The Advisory Board Company. Photo: Andrew Zaleski
Five big trends will shape the business of cancer care in 2017, according to Lindsay Conway, a managing director of The Advisory Board Company in Washington, D.C. As part of the company’s Research and Insights division, she conducts research for The Advisory Board Company’s Oncology Roundtable on topics such as the effects of healthcare reform on cancer patients and cancer-care providers.
At the annual meeting of the Association of Community Cancer Centers this week, Conway talked about trends impacting cancer care, some of which I’ve highlighted.
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Reimbursement and reform are at a turning point.
The healthcare industry is “continuing to grapple with how to deal with cost,” Conway said, something that will “remain true regardless of what happens in Congress.” As healthcare repeal, reform, and replace continues to be debated by D.C.’s lawmakers, the question then becomes: What happens in the interim that will drive high-quality cancer care at a lower cost? Conway said private payers can do their own reform. She added that private payers are increasingly aggressive about pushing cancer patients to lower-priced care. Instead of paying for infusion therapy at the hospital, for instance, private insurera may suggest having it done at an outpatient facility. Still, Conway’s message was cautionary. “Private payers have been on the forefront of designing value-driven ways to pay for cancer care, but we’re not going to arrive at a satisfying payment solution any time soon.”
Enhanced care navigation will be necessary as cancer patient comorbidities increase.
Cancer care programs need to worry about the services cancer patients are using across the healthcare system as they’re going through cancer treatment. As Conway said, roughly 22 percent of Medicaid patients are also dealing with ailments like diabetes, COPD, and heart disease. Citing an example from the University of Alabama at Birmingham (UAB) Health System, Conway said that enhanced navigation services are the answer to an increasingly comorbid population of cancer patients. Over the last decade at UAB, a new approach has taken shape, where care navigators work exclusively with high-risk patients and focus time on activities that might generate cost-savings. (Checking to make sure a patient is taking their medication, for instance.) The results Conway shared were huge. Of the patients in the UAB Health System who received navigation, there was a 58 percent decrease in hospitalizations. That equates to $4,000 in savings per patient to Medicare, or a total of $54 million in savings to Medicare across all patients over a two-year period.
The rise of telehealth in cancer care
Virtual care, through smartphone app or over the Internet, can reduce costs and increase access. Virtual consultations, Conway said, will increase 60 percent by 2020. They’re gaining traction now for two main reasons: value-based payment, and the ability to quickly and easily do things like monitor patients at home remotely. Conway cited the University of Michigan’s Breast Cancer Ally app as one of the revolutionary models of virtual care currently in use today. Oncologists introduce the app to patients once they receive their diagnosis, and then the patient and oncologist collaborate to enter pertinent information into the app. From there, the app takes over, providing information, for example, about treatment options or instructions on recommended exercises to perform after surgery. As Conway said, the app serves the dual purposes of virtual care: improving patient education and a patient’s ability to make complex decisions about their breast cancer treatment in consultation with their oncology team.
Patients are acting more and more like consumers.
“Patients have increasing expectations for service, convenience, and coordination of their care,” Conway said. Learning about providers and treatment options is getting easier thanks to the wealth of information available online. Even for patients who don’t have Internet access, a friend or family member usually steps in to direct and help out with online research. Perhaps most surprising: Online reviews cancer patients read on websites like Zocdoc and Angie’s List are more persuasive than experiences shared by friends or family members. Conway said 69 percent of cancer patients in a recent survey said they’d be inclined to switch care providers if they read a negative review online.
Navigating precision medicine
A variety of key innovations are revolutionizing how oncologists are treating cancer. How much of a dent those innovations, like hormone therapy and next-generation sequencing, are making all depends on how widespread they are. (The former is almost standard practice, whereas next-gen sequencing — capturing genomic information about a cancer — is still being perfected.) But as precision medicine becomes more prevalent, cancer care organizations will need to navigate three challenges, Conway said: how to make sense of new developments in precision medicine; how to prioritize investments in new medical equipment and facilities; and how to operationalize their approaches by making sure key care providers receive ongoing and up-to-date education. “We are all betting big on the promise of precision medicine,” she said.
