Bringing Oncology Pharmacy Leaders, Payers Together to Address Unmet Educational Needs in the Field

Pharmacy Times interviewed Bhavesh Shah, RPh, BCOP, steering committee co-chair of the 2022 Advanced Topics for Oncology Pharmacy Professionals (ATOPP) Summit, on what ATOPP is as an organization and highlights of the upcoming ATOPP annual summit in San Diego, California taking place from July 14 to July 16, 2022.

Question: Could you tell me a bit about how the ATOPP summit impacts the oncology pharmacy field and about your work on the ATOPP steering committee?

Bhavesh Shah: I feel like more and more people are asking, ‘What is ATOPP,’ because it's a new organization, and how to get involved with it and should they get involved with it. So, on the website, we actually develop FAQs, where people can learn what ATOPP is, and the genesis of it. Really, I think that a lot of the confusion has always been is it a community focus, is it IDN focus, who is the audience for this. So, we didn't want to create a disparity where you have to go to so many different conference or educational events. There are institutions that do pediatric and adult, and it's kind of also separates those specialists who work in the same institution.

So, we thought that we have a lot of folks who are on our program planning committee too, with expertise in pediatrics, and it was definitely an unmet need. So we kind of added a lot of content in the conference for pediatrics. So, I think the way I explain it to somebody when they're asking about ATOPP is that it's designed for a lot of your seasoned oncology leaders or pharmacists across the country to elevate the level of interactions that you have.

So, there's different levels in oncology. You have your directors, your VPS, and then your managers, and then your specialists. So, essentially, having presence from all of those leaders, I think, helps develop more conversations that you can solve, a lot of times, where you have an issue that kind of is presented by a specialist, and essentially goes up to a manager, or it goes up to a director, maybe the VP afterwards, so it takes a significant amount of time to solve something, or even identify that there was a problem. But if you're actually talking at the leadership level, you're able to change things much faster.

So, we purposely actually made sure that the leaders were actually at the table so that this is what the whole reverse expo is. There is about 40 plus VPs and directors from major cancer centers, not just health systems, but community practices, too. So really kind of a broad leadership community coming to ATOPP and then having also industry interact with those leaders, they can also actually have a much meaningful conversation. If there's a contract that can benefit that institution, it should be presented to the right person, and sometimes that gap that a lot of times from both sides where industry doesn't have access to the right person, and then the director doesn't know that there's a contract. So we thought that it would be really beneficial to actually bring everybody together, where we can provide education and solve a lot of the issues at hand.

So, the focus of the steering committee has really been to help guide and lead a lot of the initiatives that we're working on and really have some oversight and guidance in having seasoned steering committee members who've actually also been part of previous organizations where there are founders, so they have a lot of experience and are able to guide the agenda, a lot of the interactions, and how do we actually make things better having visibility on how other organizations put together their agendas. It helps us with how we can do better. So, I think this steering committee really was helping to steer a lot of them.

For example, one of the things that we had identified was, many industry partners want to do product theaters, which are great, but the feedback that we've gotten from our audience was that that's not something that they would like to attend, and it was not well attended in our last meeting. So really, the steering committee to this task was to actually provide benefits for industry partners, and then also bring value to our attendees. If we're really designing a solution for leaders, and seasoned leaders in oncology, we want to do better than just provide them manufacturer labeling information.

So, we actually came up with a lot of programs, essentially, called coffee conversations called ‘Spill the Tea,’ where it's very casual conversations about complicated cases or specific topics in mind. So really kind of bringing a group of leaders together in oncology to talk about a specific disease, or a specific case, or so I think it brings value to the industry partners, where it may be actually something that they want feedback on, and they want to understand how the oncology community is actually grasping this disease or managing this these types of cases. So, really kind of bringing the folks together in terms of discussions more casual, which provides the attendees with the choice of which topics they want to attend.

So, it kind of also brings value where they could go to an ITP discussion, because we know, there is emerging treatments coming out for ITP. There are constantly changes in practice, because of COVID and emerging data, so it could definitely be engaging to learn about this in a casual format. So I think really, getting away from the product theatres, where you're not actually looking at the package insert information, and having to be on label for everything—that doesn't bring value because you already know all that information, as that's on the label. So, then being able to interact with other specialists and leaders in that disease to learn from them. So I think we thought having a very free style with various types of these events embedded into the conference will be really valuable, and the topics can be chosen by our industry partners, and then audience can attend, based on their needs, in education in those topics, or in those areas of expertise.

So I think really making it more appealing from an educational perspective, so I think that's a uniqueness that we have. Of course, I think every single lecture is worth going to, but if I was to highlight, I think—the steering committee was like, ‘What is the major things that institutions are thinking about currently in what are top of the mind.’

Essentially so, one of the things that we identified was many institutions were trying to develop a hospital at home program, and we've never seen anybody present any information on hospital at home program at any conferences, and how to do that, and then what successful looks like, what's not successful, so we actually pulled together institutions that are currently doing it across the country, so one in the East Coast, one in Midwest, or maybe it's just East Coast, but really kind of pulling those institutions together to talk about where they are with their program, and what it took to develop that and share best practices. Then we also have CMS, who actually will answer a lot of questions that institutions may have, who are either considering it, or actually have gone through the process and have successfully done it, but there's issues with reimbursement or provide feedback to CMS that, ‘Hey, maybe you can do this better.’ So really it’s going to be very well attended, very engaging from all the leaders who are have a program or considering it, you have actually CMS there and leaders talking about that.

So, of course, as I said, I think one of the biggest obviously choosing the keynote speaker. I think that's very important. It took a lot of thought into it I think we looked at, obviously, other organizations, and also feedback from our teams and our audience, that what's the biggest unmet need is health inequities in oncology. It is on the top of mind for every single institution, even manufacturers, how can we increase access to our drugs, how can we increase access to innovative clinical trials to patients with diversity and inclusion, and really, I think we searched high and low when identifying the right speaker for the keynote, and with the Arya, who's been in this space for a very long time, and she's done a lot of work, and we thought that it would be perfect to actually bring in somebody with a lot of background and experience in the space to really basically bring to light what can we do when having the leaders in the room, having industry partners in the room, in terms of closing the gap in health inequities in oncology.

So, really, I think, obviously, I can go on and on about all of the great sessions and how much thought we put into them in terms of choosing a lot of things that we have, but I think just highlighting those few are probably top of my mind. Then I think in terms of just in the field of oncology, it's ever evolving, I mean, there's so many things that you can do professionally in oncology. You can specialize in a specific disease. I mean I think we've seen more specialization from pharmacists where they're more focused specifically on GU, myeloma, or BMT. So really, there's so much evolvement professionally that oncology has.

Then I think, really, there's definitely been a shift of many of my colleagues. I mean, we saw Larry Buie, who was actually the president of HOPA went to BMS, a huge statement there. What is going on here with such a big shift, and I think that goes to, basically, the keynote that HOPA had in terms of pharmacy burnout. Industry is not this place where the grass is always green and this rosy picture. There are definitely a lot of challenges with industry that you have, but I think the more people are looking for that remote opportunity they're starting a family and the traveling and commute that they may have.

So not to mention, hospitals are very stressful, especially with COVID-19. I mean we've gone through so many different surges, and I think people are just burnt out. So I think there's burnout that actually eventually leads to kind of people thinking about, ‘Hey, I'm going to try something different, this is my opportunity.’ I mean, you're actually able to make changes professionally. And if you don't, if it doesn't work out, there's plenty of oncology pharmacy specialist jobs. I mean, I have 4 positions open right now. So I think there's a shortage, and that's in oncology on the health system side, so I think that there's definitely a concern from I mean, obviously, from our community that, if this continues, how do we actually—we just added another oncology resident to our pool, but I think more institutions will actually have to consider adding more residency spots in order to grow more oncology specialists professionally.

So I think there's definitely, I mean, in a positive way, I feel like having people who are more have experienced in patient care, being involved in the day to day in an organization or a health system can provide a lot of value to industry, essentially because it feels like there's always this missing part with how did they come up with this, where did they come up with this formulation, did they not talk to a pharmacist before they develop this, this type of service or product—so I think really, there's a benefit for industry in a way where they're also getting a lot of good talent that could help them with better positioning their products and better partnerships, better value that they would be able to create with that type of expertise. So I think, really, it's a good, but there's always going to be a bad that you have to consider one side is always going to imbalance the other right.

So, I think the other questions you think we talked about kind of where can our audience go for kind of understanding what a top is, and I think the exciting part is that we had our first meeting last year, second meeting this year, we've already confirmed our third meeting next year in New Orleans. So I think, it’s really exciting that we're actually already on our way to our third meeting and are in our audience continues to grow. I think we're definitely doing something right, where we have so much excitement around our conference, and then partnerships—I think those are the ways really if we didn't offer the value that we're able to provide, I think we wouldn't have all the partnerships that we have in terms of the sponsorships.

Then the uniqueness, I feel like is always, what helps kind of drive educational organizations like this are what is the uniqueness? There's continuing education that I can get from any anything, but is this relevant to my practice, is this what I'm going to take back, is this something that's going to fill a gap, and I think, as more oncology leaders kind of see this, I think that we're going to get that to continue to grow the membership and really kind of continue to evolve the scope of our organization where I think we already had it and we want to focus on making sure that we're not actually just doing one thing a year, and then that's it.

So we have a lot of ancillary events that we're doing on the side or before the next conference, so we have educational CEs that we put out, again, similar to what we're doing in understanding what are the unmet needs, so we're working on a precision medicine continuing education activity, which is essentially bringing together a pathologist, medical oncologist, a pharmacist and a payer together, and they're talking about how, of course, you have all these FDA-approved testing that you can do for biomarkers, but we saw last year at ASCO, that lung cancer, which has the most amount of biomarker testing done, but 50% of patients are actually not getting all the tests that they should be, even though there's FDA approved treatments, not all the patients are getting that. Then if you look at African Americans, it's actually even lower. So really, we wanted to kind of bring together is this a payer issue, a provider issue, a pathology issue—are the pathologists falling asleep? So really, kind of talking through a lot of the inefficiencies that could lead to this, and how can we, by having these discussions, be stimulated to actually go back to practice and say, ‘Hey, why don't I actually have a connection with my pathologist and my molecular pathologist and my interventional radiologist, and my medical oncologist, and why isn't the pharmacy involved in helping to support this.’ We're just basically on the back end where, ‘Hey, this patient has the EGFR mutation, they can have this medication, right?’ Pharmacy is not involved in this train of thought, where until there is an actual mutation, and then a prescription.

So, I think really, what we developed at our institution is actually a weekly meeting that we have with our pathology and our medical oncology on various diseases, so kind of having an operational meeting to understand what do we need to fix not just for biomarkers, but all the broad molecular testing that we're doing her to PDL? One liquid, so, we want to make sure that we're actually supporting the providers, because when you have 40 plus providers across 50 different malignancies, and there's a lot of different testing that needs to happen. There needs to be constant communication because of the changes. I need, for example, SDK mutation, because it's going to tell me that a patient with PDL1 therapy, so they have a poor prognosis, and that's important to know. But that's emerging data the pathologist does not know, and the medical oncologist does not know if our NGS testing in house, we can do that, or if this is something that needs to go to external. So by having this collaboration and having this type of operational meeting, because a lot of folks actually have tumor boards, which are more clinical meetings.

So it's really kind of evolving to a more of an operational meeting to understand what are the inefficiencies that are causing this type of testing, because it's not just patients that don't have access to it, there is something in the system that's broken, where maybe the interventional radiologist doesn't know that this is a stage 4 lung cancer, and they're going to do NGS testing, and he needs to get as much tumor as possible. Because you can't do cytology, pathology, and the NGS testing with just one tumor sample, right. So I think it's like basically identifying all of those inefficiencies to close the gap in getting access, I don't think that you can solve this by just having the medical oncologist just try to do this on their own because there's so many other things going on. There is patient care, they're on-call, they are paged going in left and right. I mean, so having this structure, I think, can help overcome a lot of the barriers to access to precision medicine, which we know is driving oncology significantly. Then so I think really doing these types of important educational activities this is where like ATOPP really kind of comes together where it's not just clinical, and I'll also create another conference to go for your administrative knowledge that you need to gain, that there should be clinical and administrative together.

I think the other uniqueness about ATOPP is that we want to get more payers involved into our educational activities, because I feel like a lot of the problems that we see happening is because payers are not educated and in the differences and the change in data on how we function, so I think having more payers, we’ll probably have at least 2 or 3 payers this year, and I think that's going to broaden to much higher number of payers. So I think more and more, we're going to see more payers attending our conference and education and participate in our educational sessions.

I think one of the symposiums that we have is, there's a very simple symposium, it's IV iron. And you're like, what's so fascinating and about fascinating about IV iron and right, but we know that each institution is actually struggling with managing patients with IV iron, and because of the volume of patients that they have, there's no structure in terms of managing patients. There's a backlog and we know that if a patient doesn't get IV iron, they will actually end up getting a transfusion, or get admitted to the hospital, or actually miss their chemotherapy because they're too anemic to get treated.

So, we really, also wanted to kind of create education on a simple topic, that's just not well publicized that there's a focus on therapeutics, but not the supportive care and not IV iron. So, I think, really kind of talking about a lot of the different formulations, how you can be more efficient in managing patients we've eliminated probably about 900 hours of chair time by optimizing our IV iron. Imagine what you can do in any clinic when you actually eliminate 900 hours of chair time. It's basically increasing access, efficiencies, revenues, patient satisfaction, nursing time, nursing satisfaction. So, I think there's a lot of economic things that we miss when we're thinking about a simple product like that could impact a clog in your clinic that can decrease your efficiency, decrease the side of patient satisfaction, because they're coming in every week, or they're sitting in a chair for an hour.

So I think all those things are really kind of designed by our program planning committee and our steering committee kind of collaboration in terms of what are the real things that are happening that are impacting people in their clinic, and how can we help them by putting an educational activity around a lot of these topics.