Cancer Politics and Policy Today

Christian G. Downs, JD, MHA, executive director of the Association of Community Cancer Centers, discusses cancer politics and policy today.

Alana Hippensteele: Hi, I'm Alana Hippensteele from Pharmacy Times. Before we get started, one of our top articles today is about the power of social media in pharmacy in the age of COVID-19, discussing the important ways social media can help pharmacists’ voices get heard during this pandemic. There's more of that on pharmacytimes.com.

Today, I'm speaking with Christian Downs from Association of Community Cancer Centers on cancer politics and policy. So, Christian how do you see COVID-19 changing the future of community oncology?

Christian Downs: Yeah, there's a couple of key factors that I think we're going to have to look at going forward. It's interesting right now, if you look at community oncology, one of the things that we're seeing is that it's not necessarily that in many markets we're seeing an overconsumption of resources, in other words, there's too many patients quickly consuming a lot of the healthcare resources. We're actually saying just the opposite, where we're frankly not seeing enough patients, and that includes those in community oncology, both in the office as well as the program setting, so we're starting to see patients that that used to come in on a regular basis not come in. So, we're not seeing consultations, and we're not seeing new patients. So, I think that's going to be something to try to take a look at and understand.

So, the first thing is the current situation we’re in right now, which is seeing not seeing enough patients, and the second thing I think is going to follow along is, at some point, there's going to be some pent up demand, and we're going to see all these patients flood into our programs. Then we're going to have a totally different challenge.

Alana Hippensteele: Absolutely. One of the ways that I understand community oncology has been able to support patients during COVID-19 is through accelerating telehealth and telehealth as a resource. How is telehealth currently being used to support patients?

Christian Downs: Yeah, and I think it's very interesting when we say telehealth, because I think we can break it two categories. There's the clinical telehealth aspect, where a physician is talking to a patient or family member, that's one, and then there's an element of what we call telehelp, which could be supportive care services like financial counseling, a question for your pharmacist, those types of things. Now what's interesting about both of those, while CMS has produced some regulations on the telehealth side of the equation, that doesn’t necessarily mean that the state scope of practice laws allow you to do that and have other regulatory challenges that exist on the telehealth side.

On the telehelp side, what's been interesting about that is a lot of programs have had to speed that up very quickly because, if you think of people like the financial advocates, or social workers, or patient representatives, many of those folks are actually now having to work from home also. So, they're having to have these interactions, kind of like what we're having now over Zoom, and, of course, the challenge that exists then, and this is partly about telehealth and telehelp, is: What's your patient population? I'll give a lot of credit to those over 50, and I'm in that category now, we're doing okay, we're holding our own in regards to some of this technology, but I do think that if you're in a population that has, you know, a high incidence of low technology usage, telehealth and telehelp may not get you where you want to go. That's one thing, so your population, and the second thing is your provider community, which is: are they comfortable with this, do they have familiarity with this?

We're seeing a lot of ramping up very quickly of telehealth and telehelp programs, and anytime you do something that quickly, that fast, things can go wrong. Having said that, I think the long term bodes well for the increased use of telehealth and telehelp in community oncology. We just need to make sure it's supported; we have a bad habit of doing things, and then not figuring out whether or not it could be reimbursed. And we need to make sure we get that part, just so we can keep it around, and we can expand it and make it better.

Alana Hippensteele: Absolutely. So, I understand that telehealth is able to support a patient-centric perspective, in certain ways. How would that patient-centric perspective, through either telehealth or telehelp, specifically be valuable in community oncology?

Christian Downs: Yeah, well you know one thing I think we need to think about, particularly when we start talking about community oncology is: We have the medical oncology component in the equation, and we see that's where we see a lot of time spent with patients. But then, let's not forget we also have a radiation oncology, surgical oncology, in many case ethology and diagnostic lab, and various other parts of the cancer care treatment team, so I want to make sure that one of the things that we do with any type of telehealth or telehelp, is that’s able to cut across those multiple service lines, so your experience can be seamless. So that if I have a question for my surgeon, I can talk to my surgeon, and if I have a question for my radiation oncologist, I can talk to my radiation oncologist. Because in some places, particularly in the community setting, those aren't necessarily woven together as well as we want them to be. And that doesn't mean that there has to be a denigrated delivery network, in fact, some of the worst people in care coordination have to be in their delivery networks, but I think when you start getting out to the community setting, you really do need to be able to see this type of thing spread, not only to just the medical oncology experience, but all the other experiences, including pharmacy, which I think is one area that we have not done. I think one of the greatest things we could do is get some of this telehealth or telehelp into the pharmacy, so that those questions can get asked. You can get the pharmacist engaged in this, questions can get asked really fast, get done, and people feel confident, off they go.

Alana Hippensteele: Absolutely, and I know there's been a real push to get that kind of access for pharmacists, especially during COVID-19. So, do you see telehealth replacing much of the traditional inpatient visits post COVID-19?

Christian Downs: Well again, I think that's going to be community by community specific. You know, I think in some areas of the country, depending on the patient mix and the provider mix, you could see a comfort with telehealth and telehelp. Although I think it's very interesting, because if you start to look at some of the things that happened before COVID-19, you know, it just looked at some of the studies that were done around things like FaceTime, and those primary care physicians that offered the ability to, you know, look at a rash over the phone, and those type of things. Those services weren't necessarily, you know, oddly enough, taken up in a timely fashion, so I’m curious if the things that prevented those things from being as successful as we thought they might be will continue post COVID-19 work. Or, are people more familiar enough with it now, where they’re like, ‘I guess that wasn’t so bad,’ but I do think it's going to be really market specific. If you're in an area where both the providers and patients can embrace the technology, more or less, I think you'll see it take off. But then, I think I could see very easily some markets going back to a ‘come on in’ more traditional experience.

Alana Hippensteele: Yeah, absolutely. So, I understand COA has recently released a statement on home infusion. How is COVID-19 currently impacting discussions around home infusion, perhaps within the industry as a whole?

Christian Downs: Yeah, it's been interesting. The whole home infusion discussion was one of those kinds of funny things where, you're like, ‘Well, where did that come from all of a sudden?’ Because that really hadn't been, you know, widely discussed. Then maybe it's because, okay, patients are being quarantined, but, you know, you can chunk the home infusion up in a couple of different things. I think it's probably very valid arguing around the safety piece of the equation, there's that to it. But I almost take, let's take a moment: look at maybe the practicality of it, let's just focus on that. And the reason I want to focus on the practicality of it is because there's lots of things we can be doing, and not just home fusion, lots of things we can be doing. And we need to put our energy into stuff that's going to get us the most bang for our buck.

I'm not sure home infusion is one of those things, and let me tell you why: First the practicality of it, because, you know, I don't have a clinical background, you know, in fact I have a legal background, which is probably far worse, but that doesn't prevent me from talking about things I don’t know much about. What I really think is important there is: When you looking from a practicality standpoint, there's not that many products that you could really greenlight saying that I feel completely safe in giving those to patients you know, and not just the patient will crash, but, you know, that's complex, so complex. There's only a limited number of drugs that can probably fit into that, so that's one.

The second thing for practicality is: It's not like we've got hundreds of people waiting around, qualified people, waiting around to go and deliver these products. If I'm already having a workforce shortage right now, while it's convenient, it's not necessarily the most efficient delivery care, so to have a pharmacist or nurse go house to house, where maybe they see 4 or 5 patients a day, when if they come to the clinic they can see 20 or 30 patients, I think that that's one of the challenges that you have. So you have from the practicality business standpoint, you know, is it: Do you really have the number of drugs that you can give, you know, green-lighted to be able to give it all in one, and two: do you frankly have people that could do it. I bet you look at most places in the country because, today, I was just talking to some friends who actually have some home healthcare businesses, and they say, you know, there's a lot of things we'd like to do in home health care, home infusion of chemotherapeutic agents is pretty far down on the list. So, you know there's things they're going to want to do that are going to be more profitable and better for home bound patients than infusion of chemotherapeutic agents. So, I just don't see us spending a whole lot of energy on this and getting a lot out.

Alana Hippensteele: Right, absolutely. Thank you so much for taking the time with me today. Now let's hear from some of our other MJH Life Sciences brands on their latest headlines.