A session at the Association of Community Cancer Centers (ACCC) 48^th Annual Meeting and Cancer Center Business Summit brought together industry experts to discuss innovations and obstacles in precision medicine and value-based payment in oncology. 

The panel participants included Alexis Finkelberg Bortniker, JD, Partner, Foley & Lardner; Ira Klein, MD, MBA, FACP, Vice President, Medical Affairs & Payer Relations, Tempus Labs; Deirdre Saulet, PhD, Expert Partner, Advisory Board Company; James Hamrick, MD, MPH, Vice President, Clinical Oncology, Flatiron Health; and Nate Walcker, MBA, Chief Executive Officer, Florida Cancer Specialists & Research Institute.

“Value may be one of the most overused words in health care,” said Dr Saulet, explaining that the definition of value varies significantly. When defining value, Dr Saulet believes patients and patient-centered care should be at the forefront. 

Advances in technology have the ability to scale the innovations in precision medicine to all patients, no matter where they receive care. Dr Hamrick stressed the importance of clinical trials and ensuring the oncologist knows which clinical trials their patients may qualify for. Clinical trials give patients an opportunity for state-of-the-art treatment, their participation helps add to the research on that type of cancer, and the costs for treatment are covered for the patient. 

Costs and a lack of lab resources within health clinics inhibit a patient’s ability to get tested quickly, receive results quickly, and therefore receive the appropriate treatment quickly. Dr Hamrick said that, under the current system, ordering the tests for patients can feel “clunky” for oncologists, and receiving the results can take far too long. Dr Hamrick believes that these obstacles stem from the instructions and lack of information given to oncologists, highlighting a need for information to be added into the workflow to make it easier for clinicians to do the right thing and harder to do the wrong thing.

In the conversation on how technology can help oncologists and patients with cancer, data and costs of building the infrastructure were at the center. 

“In talking about tests, we have this idea that it’s expensive,” said Ira Klein, MD, MBA, FACP, Vice President, Medical Affairs & Payer Relations, Tempus Labs, arguing, “it’s not expensive.” He believes that next generation sequencing itself is becoming a commodity, and therefore believes that the barrier to testing isn’t cost, it’s establishing the “best applications” that may be the barrier. 

Dr Hamrick said that gathering the necessary data and making sense of it is contributing to the high costs in cancer care, and he believes that if technology can sort through that data and give oncologists direct guidance based on that organized data, it could cut costs. 

Dr Saulet addressed the aspect of payment, touching on the question of who exactly is paying for these data advancements in oncology. She added that going through more than one type of treatment is not good for anyone in the process of treating cancer. Failed treatments hurt everyone involved. With efficient precision medicine, this could be avoided with access to as much knowledge as possible about the tumor’s biology.

Dr Klein said that payers like the concept of technology in precision medicine but feel hesitant about the execution. “The problem is that you have enough players in this game of precision medicine—both industrial-scale companies and some of the NCI-Designated Cancer Centers who create very high-quality tests—but there’s no clear leader of who could set the standard,” he said. Dr Klein believes that without a standard, payers don’t know how to execute buying in to precision medicine. 

Nate Walcker, MBA, Chief Executive Officer, Florida Cancer Specialists & Research Institute, said that it can be hard to digest all the new information related to precision medicine, adding that there is an additional burden because clinician’s have been experiencing burnout and fatigue. It is difficult to keep up with the latest on precision medicine. 

Lastly, Dr Saulet discussed existing disparities in genomic testing, stating that established research has heavy bias for White patients. “We need to consider not only who we’re including when we’re designing clinical studies, but who we’re excluding.”  She believes that patient-centered care can help oncologists understand more about what the barriers in precision medicine may be.