COA Tackles PBMs, Big Data, and the OCM at Annual Meeting

The real impetus for fueling the Cancer Moonshot is coming from community oncology practices, not large research institutions, according to the Community Oncology Alliance.

Ted Okon, MBA

The real impetus for fueling the Cancer Moonshot is coming from community oncology practices, not large research institutions, according to the Community Oncology Alliance (COA), which has made that the theme of its 2017 conference next week in National Harbor, MD. This year’s meeting at the Gaylord National Resort and Convention Center starts on Thursday, April 27, and features a packed agenda with broad scope of talks on legislative, clinical, and pharmacy issues. A record-breaking crowd of 1300 providers, pharmacy workers, payers, and employers is expected, Ted Okon, MBA, executive director of COA, said in an interview.

A powerhouse of clinical research in the community setting is supporting the Moonshot initiative to accelerate cancer discovery, Okon said. Independent cancer centers are expanding practical knowledge of drugs that are “not only palliative but also curative,” Okon said.

Big Data also is key to advancing the frontier of cancer treatment, and the conference will address the relevance of the digital role in discovery in a talk entitled “Is the Rubber Meeting the Road?” delivered by Robert Green, MD, senior vice president of Clinical Oncology for Flatiron Health. “We need to do a better job in terms of capturing all of that clinical data that’s not captured now or is captured in an unformatted way—turning that into a useable database,” Okon said.

A second prong in the Big Data focus will concern payment initiatives, such as how to analyze claims data, report on it, and capitalize on trends. Basit Chaudhry, MD, PhD, founder and CEO of Tuple Health, will lead a presentation on this topic.

A key legislative focus of the conference this year is an exploration of the impact pharmacy benefit managers (PBMs) are having on the independent practice community. PBMs are expanding their control of drug distribution and complicating the task of ensuring patient adherence and appropriate follow-through on therapy pathways, according to COA. “These PBM issues have become so pronounced,” Okon said, noting that this year COA has added a separate pharmacy track to deal more specifically with PBM concerns. However, the conference opening presentations will include a provocative general session panel discussion titled “Pharmacy Benefit Managers: Profits Over Patients.” It includes US Rep Earl L. “Buddy” Carter (R, Georgia), who owns a pharmacy in southern Georgia and has struggled with business regulation and its effects throughout his more-than-30-year business career. Separate pharmacy presentations will address orals adherence and dispensing challenges, including a focus on the legal side of these issues.

Coinciding with the focus on drug dispensing, COA is preparing to release 2 reports on PBMs and their impact on patient care. These contain anecdotes from dispensaries and providers around the country on alleged breakdowns in the quality of patient care associated with PBMs, Okon said. “We’ve been compiling stories. We put the word out to our pharmacy association, and it was like opening up Pandora’s box. We keep on hearing horror stories about PBMs literally changing physician’s orders, changing doses, and restricting access to drugs. Patients have waited months in some cases and not gotten access in others.”

The annual meeting has been tailored to engage employers with discussion on employer involvement in clinical care and payment models. A Thursday afternoon panel will include representation from Southwest Airlines.

The Oncology Care Model (OCM) figures largely in the present and future of many independent practices, and that is very much a central theme in this year’s conference. COA is offering a series of talks and presentations, including a workshop, on OCM implementation and lessons learned so far. Okon and Kavita Patel, MD, a policy analyst with The Brookings Institution, will discuss a wish list of modifications to the OCM that Okon said would transcend some of the less practical aspects of the CMS model of care. COA is calling the modified version “OCM 2.0.” Whereas the OCM has been criticized for its 6-month bundled payments that appear to start and end at arbitrary points in a patient’s care, OCM 2.0 “is much more natural,” Okon said. “It’s looking at when the patient is diagnosed, whether the patient is getting chemotherapy, pure biological or oral drugs, surgery, radiation, or any combination of those.”

Against the backdrop of a moving line of scrimmage on whether and how to change healthcare as defined by the Affordable Care Act, COA plans a full panel discussion on this and other legislative issues. The conference includes field trips to congressional offices for introductions, along with a full slate of advocacy discussions and workshops designed to strengthen and solidify the presence of independent providers in the oncology treatment landscape. “We’ll talk about site payment parity, new legislation on oncology payment reform, and other issues,” Okon said.

The keynote speaker for this year’s conference is Scott Hamilton, a 1984 Olympic gold medalist in figure skating. Hamilton has battled cancer throughout his life. When he was 2 years old, his growth was stunted by what turned out to be a brain tumor. He won a fight against testicular cancer in 1997, and last August he was diagnosed with his third brain tumor—a benign pituitary growth. Prior to the conference, Okon met with Hamilton at his home in Franklin, Tennessee, for an interview. He described Hamilton as very “genuine” and said his message for conference attendees is one of teamwork: “He’s got a good perspective on the importance of the whole team around you—the nurses, the oncologists.”

Finally, this year’s conference includes a heightened focus on the clinical side of care, an effort by COA to round out the offerings and provide more of a one-stop conference for the independent providers it represents. Sessions include presentations on targeted treatment and immunotherapies in lung cancer, next generation sequencing, rehabilitation for cancer survivors, and updates on management of breast, myeloma, lymphoma, and genitourinary disease.

Visit regularly during the conference for news and reports on the discussions and presentations.