#ACCCNOC: Financial Advocacy, Value-Based Care + Biomarker Testing

The Association of Community Cancer Centers (ACCC) will welcome more than 600 attendees over a 3-day span (October 4-6) to Austin, Texas this week for the highly anticipated ACCC 40^th National Oncology Conference. Day 1 of the meeting included a Pre-Conference focused on the ACCC Financial Advocacy Network (FAN), an exclusive session on electronic health record (EHR) integration to facilitate timely and comprehensive biomarker testing, and an enlightening discussion on the importance of delivering value-based care while juggling alternative payment models. 

Lessons from Financial Advocates

In opening the ACCC Financial Advocacy Network Pre-Conference, the network’s chair Angie Santiago, CRCS, manager of Oncology Financial Advocacy at Sidney Kimmel Cancer Center at the Thomas Jefferson University Health System, shared a personal story that reinforced her dedication to the field. “On May 22 this year, my grandmother was admitted into the ER [emergency room] with what turned out to be breast cancer,” she said. According to Santiago, although her experience as a financial advocate ensured she was prepared to help her grandmother navigate the cancer care continuum, a few things surprised her.

“As oncology financial advocates, we often do not think of how many appointments a patient goes through before they begin treatment,” Santiago said. “My grandmother had 10 appointments before she started treatment on July 18.” Santiago enrolled her grandmother in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Health System compassion program, which eliminated her co-pay costs. However, Santiago understands that many newly diagnosed patients with cancer are not readily afforded such resources—thus emphasizing the need for financial advocacy. “We need to be there for every patient. Let us think about helping our patients with more permanent solutions, rather than temporary solutions,” Santiago concluded.

Santiago’s place on stage was taken by Rifeta Kajdić Hodžić, senior program manager at ACCC. Kajdić Hodžić shared data from an ACCC census survey conducted across 31 states, designed to explore the staffing trends for oncology financial advocacy programs, effective practices for financial distress screening, and the major challenges in helping patients access financial assistance programs. “We are happy to report that there has been a lot of growth in the role,” Kajdić Hodžić said. “We are trending in the right direction, however we are not where we want to be yet, as financial toxicity is still growing.” According to Kajdić Hodžić, the survey revealed that rural cancer centers and programs were not utilizing their EHR as well as their counterparts in urban areas. Further, she pointed out that there are significant gaps and opportunities to screen patients for financial distress.

Of particular interest to attendees was Kajdić Hodžić’s revelation that 24% of the survey respondents answered, “yes,” to this question: Have you ever not recommended FAN services to a patient because of the burden? “I was hoping we would have a lower number than this,” Kajdić Hodžić said. “It is sad that 24% have said yes, and it makes you think about where the journey of the patients affected by this decision led—all the missed treatments they may have experienced.”

Building on Kajdić Hodžić’s session, Christie Mangir, vice president at Rhizome led a 10-minute group exercise that asked attendees to vote on what solutions they felt were most impactful and feasible in financial advocacy. To conclude the Pre-Conference, attendees discussed “hot topics” in the financial advocacy landscape, focusing primarily on specialty pharmacy, white bagging, payer issues, delivery of drugs, and drug shortages.

The Current Environment for Value-Based Care

The term value-based care is not new to the medical lexicon, but what does value in this context mean? Is it value to the payer? Value to the patient? Or value to the provider? According to Kathy Oubre, MS, chief executive officer at Pontchartrain Cancer Center, the definition of value is on dependent who is designing the value-based care model. “Value-based care simply provides a framework to capture and measure metrics related to the quality services we are already delivering,” Oubre said to begin the session. Oubre believes that delivering value-based care should be the goal of every cancer center or program, irrespective of their size. “No matter your practice size, value-based care is an opportunity to look at what you do well and areas where you can improve and then design an alternative payment model together,” she said.

Providing value-based care against the backdrop of changing payment models has proven challenging for cancer programs and practices in the US. However, ACCC’s Alternative Payment Model (APM) Coalition is focused on addressing concerns about lack of preparedness to perform under new payment models, patient and provider access to the latest treatments, infrastructure, and long-term sustainability.

For cancer programs and practices around the country looking to establish an APM, Oubre and her co-presenter, Colt Hatcher, vice president of Business Operations at The Center of Cancer and Blood Disorders, outlined this 3-step process:

• Identify the quality metrics you want to measure and report as well as the payer you want to partner with.
• Demonstrate the benefit(s) the APM will bring to the payer by showing how your practice or program meets these quality metrics, as well as the benefit(s) the APM will bring to patients.
• During discussions to develop and implement the APM, underscore the need for a higher degree of collaboration, communication, and transparency.

"You need to understand what makes your payers tick—what holds value for them,” Oubre said. “Then keep patients at the center of what you do, come to your payers with a value-based framework. You don't want your payers to be in the driver seat." Building on Oubre’s sentiments, Hatcher concluded the session, “Payer contracts can no longer be based on just fee-for-service reimbursement. Start now, even if it's on a small scale. Start with 1 or 2 value-based contracts."

Biomarker Testing: Solutions for EHR Integration

Key stakeholders were invited to engage in a discussion on effective practices to facilitate timely and comprehensive testing for the biomarker environment. In the opening roundtable discussion, attendees were asked, “What single barrier, if removed, would most enable more effective use of EHR for comprehensive biomarker testing?"

"Heterogeneity in biomarker testing, balancing the testing landscape—what to order, when to order—rather than a wild west of testing,” answered Christopher McNair, PhD, associate director for Data Science at Sidney Kimmel Cancer Center at the Thomas Jefferson University Health System. Sandra Kurtin, PhD, ANP-C, AOCN, assistant professor of Clinical Medicine and Adjunct Clinical and the assistant professor of Nursing at Banner University Medical Center, University of Arizona Cancer Center identified insurance authorization as the most significant barrier.

In discussing potential solutions to the barriers discussed, James Chen, MD, senior vice president, Medical Informatics at Tempus Labs Inc., believes facilitating interoperability provides a strong staring point. "We don’t have the same way of communicating at the genomic level, we don’t use the same language. We need interoperability.” Dr. Kurtin echoed Dr. Chen's sentiments, emphasizing the importance of open communication between the information technology (IT) department and clinicians at a cancer program or practice. "I like to think I’m bilingual – I speak IT and I speak clinical—I believe EHR integrations should be collaborative. We need to make IT processes reasonable for clinicians.”

Following the roundtable discussion, 3 different ACCC members shared case studies on their successful EHR integration to facilitate timely and comprehensive biomarker testing. The session concluded with breakout groups that allowed participants to share ideas for improving workflow and standardizing biomarker testing throughout the cancer care continuum. For more information on EHR integration, visit the ACCC website.