Keynote Speakers at 2019 Directions in Oncology Pharmacy Promote Quality Improvement

Enthusiastic participants attended the Directions in Oncology Pharmacy™ conference this year. Evelyn Handel, PharmD, BCPS, BCOP, director of drugs & biologics programs at the National Comprehensive Cancer Network, presented the keynote address. The keynote presentation was developed in collaboration with Emily Mackler, PharmD, BCOP, of the Michigan Oncology Quality Consortium in Ann Arbor, who presented the keynote address at the 3 earlier 2019 conferences. Dr Handel described the Medicare Access and CHIP Reauthorization Act legislation and Quality Payment Program (QPP) components and their impact on oncology practice, and more important, how every pharmacist carries a vital role and is impacting value-based care with their patients.

Dr Handel began by explaining the current state of affairs in cancer care, pointing out that it has not always been patient centered, accessible, coordinated, or evidence based. Using those tenets, she described the ideal conceptual framework. Accompanying that framework is a shift toward value-based payment. Legislation enacted in 2015 set the stage to address quality improvement and use of evidence to structure care. She went on to cover the advanced alternative payment models in oncology and innovation that includes accountable care organizations, bundled payment models, clinical pathways, patient-centered medical homes, and oncology medical homes.

Dr Handel indicated that the Centers for Medicare & Medicaid Services’ Oncology Care Model focuses on improving oncology care and maintaining or decreasing costs. Currently being tested, it is looking at real-time monthly payments, and there is potential for retrospective performance-based payment if a practice’s quality exceeds that of other practices or its cost performance exceeds its past performance. This model comes with a number of requirements, including access to an appropriate clinician at all times, patient navigation assistance, care plans that include 13 components designated by the Institute of Medicine, and use of nationally approved guidelines.

Moving on to a discussion of the Merit-based Incentive Payment System (MIPS), Dr Handel discussed the 4 performance categories—quality, promoting interoperability, improvement activities, and cost—and provided information so that audience members understood exactly how MIPS works in the oncology setting. Oncology practices must submit data for at least 6 MIPS measures. She noted that in 2019, MIPS includes 268 measures in total.

Many professional and nonprofit organizations address quality metrics, and some of them focus exclusively on oncology. Dr Handel looked at some of the most common and some of the most important, and described how various organizations can measure these aspects of care. Of importance to pharmacists practicing in this specialty, understanding the reporting mechanism and addressing gaps and baseline information are critical. She stressed that it is essential for pharmacists to assess the quality landscape in their own practices and increase their involvement in interprofessional quality committees and organizations.

Many pharmacists are unaware of their potential impact on the Choosing Wisely initiative from the American Board of Internal Medicine Foundation. Dr Handel indicated that the American Society of Clinical Oncology has posted 10 measures on choosingwisely. com, and 5 are related to medication therapy. She reviewed each and stressed interventions the pharmacist can use to improve care. Other areas in which pharmacists are essential are patient counseling and education, participation in protocol-based care, managing symptoms and providing supportive care, and medication reconciliation.

Finally, Dr Handel reminded audience members that it is critical to continue training and direct efforts toward improving care. She shared multiple resources for pharmacists to gain additional skills in this area as well as ideas for how to collaborate more widely. She also indicated that when pharmacists are successful, they need to celebrate that success and identify new opportunities for improvement.