Democratizing Cutting Edge Oncology Health Care by Broadening Access to Expertise

Due to new medications in discovery, the outcomes for patients with cancer are increasingly improving; however, the cost of this improved care is also increasing, according to Harlan Levine, MD, the president of strategy and business ventures at City of Hope, during a session at the Association of Community Cancer Centers 47th Annual Meeting & Cancer Business Summit.

Additionally, the rapidity of change in conjunction with the complexities of genomics can cause variation in the quality of care each patient receives in terms of both treatment selection and outcome, Levine explained.

“Health plans are stepping up and increasing their focus on oncology, but they’re not really able to address the needs of the patient or the cancer physician. Employers themselves are remaining committed to staying in health care, and I believe you’re going to see them taking more and more accountability on their own to drive value in health care,” Levine said during the session.

For almost every large employer, oncology is among the top 3 areas of spend, while also accounting for the highest rate of spending growth. This has caused employers to take notice of this trend, as oncology spending is roughly 12% of the overall cost of health care, while only affecting approximately 1% of the population, Levine explained. Disparities in the quality of cancer care is also increasing, with patient outcomes often being driven by the insurance provider, the demographics, and the zip code of the patient.

The issue of patient access to quality oncology health care is of specific concern for employers due to the lost productivity of an employee with cancer or a family member of an employee with cancer, as both cases can cause employee absenteeism.

“But in general, cancer is also very personal, and when one person has cancer, or a family member of an employee has cancer, it tends to impact the whole workforce,” Levine said during the session. “So, this is a keen area of interest to the employer.”

In the treatment of cancer, where the guidelines are unclear and difficult to apply to every patient, employers are finding that the current solutions available are falling short of the needs of their workforce. For this reason, they are looking for new avenues to improve the value of their dollar and improve patient outcomes, according to Levine.

“Given the cost of oncology today, for the first time in decades, employers are looking to the value of clinical trials, recognizing that care is changing fast, and oftentimes a clinical trial might offer the best solution to a member. But also many, if not most, approved clinical trials are actually subsidized, and in addition to doing the right thing for the patient and advancing care, there may be an economic advantage to allowing or facilitating access to a clinical trial,” Levine said during the session.

This employer interest in access to data from clinical trials is additionally important in light of the emergence of precision medicine, checkpoint inhibitors, cell-based therapies, and bone marrow transplant, the cost of which is rapidly accelerating, Levine said.

With genomics changing the field of oncology and published data demonstrating the great variation between the quality of care received by patients, employers are interested in improving the value of health care in order to improve patient outcomes, while attempting to maintain affordability and patient experience, according to Levine.

“I think this puts the employer in a unique position than many of the other stakeholders in health care today. They want to proactively support both the member, which is the patient with cancer, the family, and the treating physician to make sure that they have access to the most cutting-edge information, diagnostics, and therapies,” Levine said during the session.

Since not all patients have access to a high-quality cancer center in their own communities, City of Hope established an employer-facing company called AccessHope that connects delivery systems with the expertise of a National Cancer Institute-designated cancer center.

There are 3 main products that allow AccessHope to effectively make this connection. The first product is accountable precision oncology, which uses data-driven algorithms to proactively identify the most complex cancer cases in an employer population. It then supports expert second opinions for members that help to generate the best treatment plan for patients with cancer, according to Levine.

The second product is an expert opinion for patients outside of the most complex cancer cases, which is a second opinion triggered by the cancer patient, with the main point of contact remaining with the treating physician.

“In this case, we’re exporting the expertise of City of Hope and democratizing cutting-edge health care throughout the country,” Levine said during the session.

The third product is for those members who do not want a second opinion but need further support. This product is a call-in center supported by oncology trained nurses that allows patients to ask questions of these trained professionals.

“This is really a support program where we offer education and insights on how to navigate this unwanted journey of being a cancer patient,” Levine said during the session. “We get really interesting questions that range from ‘I’m about to start chemotherapy, how do I prepare for that,’ to ‘I’m about to get radiation therapy and I’m too embarrassed to ask my doctor what that is. Am I gonna glow?’ and we get the more typical questions about research and how to manage side effects.”

REFERENCE

Levine H. Progressive Employers Addressing Disparities in Cancer Care for Their Employees. Presented at: Association of Community Cancer Centers 47th Annual Meeting & Cancer Business Summit; March 4, 2021. Accessed March 4, 2021.