Building a Smarter Community: Cancer Clinics of Excellence is redefining the business of modern oncology practice

Published: Monday, Jul 21, 2008
Call it the latest take on the independent practice association (IPA), or perhaps the evolution of the group purchasing

organization (GPO). Rather than building coalitions for management efficiencies or purchasing power, Cancer Clinics of Excellence, a year-old organization that bills itself as an oncology service company, brings together physician practices around common clinical practice guidelines, with a heavy dose of information technology.  “We’re at the end of the arms race in terms of squeezing out efficiencies,” says J. Ike Nicoll, named in June as president and CEO of Cancer Centers for Excellence (CCE).  “Now, IPAs have to stand for something.” In this case, the goal is to make CCE stand for guiding care based on standards. “The GPO strategy has run its course,” agrees Oncology Net Guide editorial board member Jivesh Sharma, MD, CEO of Texas Cancer Associates, Dallas and Plano, TX. “The oncology drug business has basically become commoditized,” says Sharma, whose practice is not affiliated with CCE. He believes there is little value for a practice to switch from one of the two major oncology GPOs to the other:

OTN, formerly Oncology Therapeutics Network, a unit of McKesson; and International Oncology Network, or ION, which is part of Amerisource Bergen Specialty Group. The seeds of CCE were planted nearly three years ago, when some OTN-affiliated physicians decided that they needed to start working more closely together to help advance care in their field. The privately fi nanced company formally started in April 2007. Since that time, they have been developing treatment protocols and working with practices and software vendors to build the electronic infrastructure to facilitate collaboration.

CCE is set up as individual, physician-owned practices under the umbrella of a holding company, with no real headquarters location.  “We’re the classic virtual company,” Nicoll says. The practices own a majority of CCE, and McKesson Specialty is a corporate partner; its McKesson Specialty division has two seats on the seven-member CCE board. McKesson, the $102 billion drug distribution giant that also has an information technology unit, serves CCE with drug distribution, technology, consulting, and specialty pharmacy services.  Th e specialty pharmacy market in particular has been changing rapidly, thanks to longer survivability of cancer patients and expensive biologics. “For the fi rst time, insurance companies are starting to recognize oncology as a chronic disease,” Nicoll explains.  Sharma sees two drivers of the shift in strategy among oncology practices: the advent of pay-for-performance and the desire for more consistent treatment guidelines. “Th e main thing that attracted us was that we saw oncology changing with the [2003] Medicare Modernization Act,” says Cathy Beaker, CEO of Hematology-Oncology Centers of the Northern Rockies in Montana and Wyoming. That law changed how Medicare reimbursed for physician-delivered cancer drugs and in-offi ce oncology services. 

Hematology-Oncology Centers had been part of OTN, purely to obtain better prices on expensive chemotherapy drugs, but jumped at the chance to be a charter member of CCE. “We felt that the vision they had was our vision,” Beaker says. That vision includes the application of evidence-based treatment protocols (ETPs) among several like-minded practices that want to provide the highestquality care possible. Beaker was in on the initial planning meetings, where practice leaders discussed such collaborative eff orts as group purchasing for pricey biologic drugs and information technology. “More than anything, we really wanted to start doing evidence-based treatment protocols,” she recalls. “We want to have a forum to go to payers and say, ‘We’re doing things the right way,’” Beaker adds.  “It’s a psychographic, not a demographic,” Nicoll says of the type of practice that fi ts the CCE model. Instead of picking physicians based solely on geography or even EMR vendor, the doctors have to buy into the organizational philosophy. “This is a big commitment to step up to,” Nicoll says.

It also is geographic, to a point. CCE is starting by focusing on certain regions, including Southern California, Massachusetts, Georgia, and Florida, though it currently has operations in 14 states. Th ere has to be a critical mass in each market it plays in to provide leverage in contract negotiations with payers.  Employers that purchase insurance are increasingly looking for accountability for their substantial healthcare dollars, and guidelines have a way of holding healthcare providers accountable. “Insurance companies have very little granularity,” Nicoll says. CCE hopes to fill that void.

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