Will cancer research atrophy under Trump administration?

Chatter at an early morning session on the third day of the  43rd annual meeting in Washington, D.C., was largely focused on the state of healthcare — and the survival, or repeal, of the Affordable Care Act — under the new President Trump administration.

A conversation about the state of healthcare at the Association of Community Cancer Centers’ annual meeting mostly focused on speculation over the Affordable Care Act’s future under the Trump administration. But the discussion shifted to the standing of the Cancer Moonshot Task Force, put in place during the final year of President Obama’s tenure.

Dr. Kavita Patel of the D.C.-based think tank The Brookings Institution and Dan Todd of Todd Strategy, both former Capitol Hill staffers, said any push for increasing the funding for cancer research will most likely come from agency heads, at the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health.

“There’s a commitment on Capitol Hill,” Todd said. “But the moonshot folks all went to work with former Vice President Biden. If there’s nobody [in the White House], it’s going to atrophy.”

The task force, helmed by former Vice President Joe Biden whose son, Beau, died of brain cancer in 2015, left D.C. the same day as the rest of the White House staff when President Obama left on Jan. 20. Today, it lives on as the nonprofit Biden Cancer Initiative, and the former vice president said the nonprofit’s work will focus on bringing down the cost of cancer treatments, enabling wider access to clinical trials, and supporting community oncology efforts.

Even before Obama and Biden left the White House, national cancer research received a boost. In December, the 21st Century Cures bill was passed into law. Through the law — the Capitol Hill commitment to which Todd referred — Congress appropriated $1.8 billion in new funding for cancer research.

Whether President Trump’s White House will take up the mantle of moonshot cancer research is an uncertainty. Although former members of the Cancer Moonshot Task Force had spoken with the incoming administration about the research — which includes a conversation between Biden and his successor, Vice President Mike Pence, about continuing the work — the new White House’s proposed budget removes $6 billion in funding from the National Institutes of Health.

“Trump’s [administration] agreed to help continue some of those efforts,” Patel said. “Doing that but releasing a budget where you’re cutting the NIH by billions of dollars does not make sense to me.”

Photo: azerberber, Getty Images

The rise of oncology nurse navigators in the shift to value-based cancer care

A cancer diagnosis can be frightening and confusing for a patient. There’s where the nurse navigator comes in.

Navigators are often oncology nurses who offer individualized assistance to patients, their families, and their caregivers to overcome barriers in the healthcare system through the duration of the patient’s treatment. That might mean providing educational materials to a patient or working with a patient’s oncologists to help gain access to clinical trials. Sometimes a navigator’s tasks have nothing to do with a patient’s cancer diagnosis — like finding a babysitter. Helping patients manage their cancer care and plan for the future is quickly becoming as important as administering chemotherapy treatment for the roughly 1.68 million Americans diagnosed with cancer last year.

As of last summer, the job of a navigator became even more crucial, as Tricia Strusowski, a registered nurse and consultant with Georgia-based Oncology Solutions, explained during a talk at the Association of Community Cancer Center’s 43rd annual meeting in Washington, D.C., last week.

Advertisement

Many of the current cancer patients in the U.S. are 65 years or older and paying for treatment using Medicare benefits. In search of a new way to provide better quality and more coordinated oncology care, the Centers for Medicare and Medicaid Services (CMS) rolled out a new model for delivering care to cancer patients over the summer last year. The Oncology Care Model (OCM) is a five-year model being tested through June 2021 with nearly 200 physician groups and 17 payers. The goal: Better care, smarter spending, and, ultimately, healthier patients.

One of OCM’s hallmarks is that all the participating practices, as well as the CMS, have committed to providing enhanced services, like navigation, to cancer patients on Medicare. Already some early results from several participating practices are showing the difference. At one oncology practice in Pennsylvania, enhanced services including navigation have resulted in a 51 percent drop in emergency room visits among cancer patients.

But as the role of the navigator becomes more important, so too does the means by which navigators can measure job performance. As of this year, a new set of 35 navigation metrics is available to oncology practices participating in the OCM. The metrics are a baseline, which can be used by any medical institution, and were developed in part by Strusowski, — she was one of the team leaders of the Standardized Metrics Task Force of the Academy of Oncology Nurse and Patient Navigators.

As the Journal of Oncology Navigation & Survivorship noted in January, the metrics set guidelines on how navigators should communicate with patients and healthcare providers to help coordinate cancer care, “evaluate professional practice and care delivery and measure the impact of navigation.”

During her talk, Strusowski mentioned that the metrics will not only help demonstrate the value of navigation, but will also help meet the OCM program’s overall goal.

“The navigator needs to stay one step ahead of the patient,” she said. “And how can you enhance the patient experience when we don’t know what to measure on our navigation programs?”

Photo: PeopleImages.com, Getty Images

Beltway insiders struggle to predict what will happen to health insurance exchanges, essential benefits

From left: Leah Ralph of ACCC, Dan Todd of Todd Strategy, and Dr. Kavita Patel of The Brookings Institution at Cancerscape conference by the Association of Cancer Care Centers in Washington, D.C.  Photo: Andrew Zaleski

Mix concern for the future well-being of the insurance exchange market along with a healthy dose of ¯_(”/)_/¯ and you’ll have a decent analysis of healthcare in the U.S. circa 2017.

At the Association of Community Cancer Center’s 43rd annual meeting this week in Washington, D.C., there was a discussion about the state of healthcare under President Trump’s administration — a timely subject, given the recent failure of House Republicans to pass the American Health Care Act (AHCA), their repeal and replace version of the Affordable Care Act, or what’s commonly known as Obamacare.

Moderated by the ACCC’s director of health policy Leah Ralph, the discussion included Dr. Kavita Patel of the Washington, D.C.-based think tank The Brookings Institution and Dan Todd of Todd Strategy. As former Capitol Hill staffers, both offered instructive comments on congressional Republicans’ failure to pass the AHCA.

“The House is always this kind of chaotic, welcome-to-the-jungle kind of mess,” Patel said. “Bottom line: They didn’t have the votes.”

Todd echoed the sentiment, also noting that a dose of political miscalculation led House Republicans to believe all their members would vote for an Obamacare repeal bill. In recent days, members of the GOP have blamed the Freedom Caucus, the more conservative wing of the Republican Party in the House, for scuttling the AHCA. (Notably, President Trump tweeted this admonishment: “The Freedom Caucus will hurt the entire Republican agenda if they don’t get on the team, & fast.”). This happened about eight minutes before the discussion on Thursday.

Political dynamics aside, what does any of this mean for cancer treatment in the U.S., and the general state of healthcare? That was the question both Patel and Todd tried to make sense of for conference attendees.

The insurance exchange marketplace is where about 10 million people currently get their insurance, and how it fares in the year ahead is what Todd tackled head-on. Since passage of the ACA seven years ago, it’s now apparent that the small group market doesn’t look like the large group market — it looks much like the Medicaid market, made up of people who are sicker and older, and is highly cost-sensitive. The fix employed by President Obama’s administration, which wasn’t contemplated in the original healthcare law, was a risk adjustment payment paid to plans.

“Will the Trump administration make those payments like the Obama administration did? My gut tells me no,” Todd said. “If no, you don’t have a healthy market.”

Patel responded in kind, noting that if the Trump administration does away with cost-sharing subsidies, the result will be “people who have cancer who can’t afford insurance.” The reason? The financial stability of the federal healthcare marketplace will begin to falter. So far, the Trump Administration hasn’t said one way or the other whether it will continue providing those subsidies for insurers who participate in the federal marketplace, although House Speaker Paul Ryan said that the Trump administration should keep making those payments to insurers “to avoid destabilizing the market,” the Wall Street Journal reported Thursday.

Patel also highlighted the essential benefits component of the ACA, which required all plans sold in the marketplace to cover cancer screening, treatment, and follow-up care. The ACA tied out-of-pocket maximums paid by patients to essential benefits.

Health and Human Services Secretary Tom Price has signaled that Republicans will dismantle elements of Obamacare even without the votes in Congress. As the Chicago Tribune reported, Price described in testimony this week how “his department could make insurance plans cheaper by scaling back several federal mandates, including what the ACA currently defines as ‘essential benefits’ in coverage.”

“You get rid of [essential benefits], you actually get rid of those out-of-pocket annual maximums, which are crucial for cancer patients,” Patel said.

Although both the White House and Ryan vowed they would renew their efforts to repeal the ACA, it’s too soon to tell what will happen with healthcare this year.

Put another way: ¯_(”/)_/¯.

Featured photo: Justin Sullivan, Getty Images

5 healthcare trends impacting cancer care

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.

Reimbursement and reform are at a turning point.

Advertisement

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.