The Road to Value-Based Care With the Quality Cancer Care Alliance

Frederick Schnell, MD, Community Oncology Alliance, and Sibel Blau, MD, Northwest Medical Specialties, CEO and President, Quality Cancer Care Alliance, discuss the rapid evolution of cancer care delivery and value-based care in the Quality Cancer Care Alliance (QCCA) Network.

Transcript

Frederick Schnell, MD: Welcome to the Journal of Clinical Pathways. My name is Dr Frederick M. Schnell. I currently work as the Chief Medical Officer of the Community Oncology Alliance as well as its subsidiary, the National Cancer Treatment Alliance.

I will be moderating the discussion today. I'm immensely pleased to be joined by Dr Sibel Blau. Dr Blau is the president and CEO of the Quality Cancer Care Alliance Network, is the Medical Director in the Oncology Division of Northwest Medical Specialties and serves also as the clinical associate professor in the hematology division at the University of Washington.

Sibel, could you introduce yourself as well and possibly give the audience some feel as to your interest in some of the things we're going to be talking about today, and focus on value-based care as we walk through.

Sibel Blau, MD: Sure. I am a hematologist/oncologist at Northwest Medical Specialties, as you mentioned, Fred. We are located in Tacoma Washington Pacific Northwest. I have been involved with both administrative duties at Northwest as well as a practicing clinician.

Over the years I have developed interest in value-based care coming from many years ago in participation of a national organization we belong to called Cancer Clinics of Excellence or CCE.

During that time, my CEO at Northwest Mark Nelson and I started talking about the future of medicine, how we're going to take place in health care, and we started building a framework on value-based care for my practice. That goes back to 2013.

At that time, there was some preliminary work or earlier work with Dr McLennan, and others. We have learned a lot of ideas from other practices after we established Quality Cancer Care Alliance Network. We are one of the founding members. As you mentioned, I'm the current CEO and president of this organization.

Our core value accuses here is value-based care and developing this research network that helps our patients and practices in ways that we cannot standing alone as independent practices provide.

Quality Cancer Care Alliance Network is an organization that clinically integrated network of independent practices coming with this idea of bringing value-based care and great research and other technology and tools that practices need to be able to survive and provide best care for their patients.

Dr Schnell: Great, thank you very much. Thanks for being with us today. I'm very pleased that you're doing this. You and I have shared firsthand the rapidly evolving changes in cancer care delivery, as value-based care—energized by the oncology care model—has forever altered I think the clinical and economic parameters of Cancer Care in America.

What do you see as the key challenges to delivering value and what does QCCA commitment to quality look like?

Dr Blau: Drug prices impact the delivery for value-based care. We cannot have any control of the drug prices as doctors or practices, it's out of our control. We do need to provide a practice transformation to do a true value-based care and deliver the true value-based care to the patients.

In order to build a program that will deliver true value-based care. We need technology, some tools, and elements that are necessary to provide it. For example, the social workers and case managers and care coordinators and lots of tools, data analytic tools, or other technologies.

Independent practices, this is very difficult to be able to provide and afford all of this because drug prices are not in our control. It is a big portion of the OCM and OCM-like programs. We need to be able to find a way to be able to pay for all these additional costs even beyond the mean house payments and anything like that.

As QCCA, what we have done is we gathered some groups to be able to go and negotiate certain tools to be able to be put into our practices and provide a program that has all those elements. Normally not affordable on your own as a standalone practice.

As part of the bigger organization, and with the similar ideas and same vision of bringing value-based care into our practices, we all benefit from that and be able to afford those components of value-based care.

Dr Schnell: Great, thanks. A particular interest area of mine, and I think also the Journal’s is use of new technology in delivering care. I wonder whether you might address how you view decision support and implementation or incorporation of new technologies and how those can prove to be affordable on a day-to-day basis if placed in a broad series of clinics?

Dr Blau: When OCM program came, and we all participated, initially, it was very obvious that without a technology and data analytic tool, we wouldn't be able to analyze and help the practice to transform in a way that can show the shared savings and really be a true value-based care.

When we looked at data analytic tools, and they are not free and it is not just usually one, but there's more than one that’s needed to complement each other. Then also, building other programs like triage pathways and clinical pathways, they all need to come with a package and software and some technological background.

If you really want to build a true program, you have to have all these elements. Otherwise, it just wouldn't be a true practice transformation. The success in OCM and OCM-like alternative payment models, is based on this kind of building, the tools, and the transformation of the practice. We at QCCA have Roche triage pathways and clinical pathways.

In fact, we are working on our own value-based care pathways at QCCA to be able to provide these functions, and especially on the clinical content, but also reaching out to all the technologies. I mentioned we're able to bring discounts and affordability to the practices so we can all benefit.

Also, a part of it is learning and sharing the best practices, not just jumping into any technology that's out there, because there's a lot of great companies out there that come to our doors, and they want to either pilot something, or they want to sell their products, which could be amazing if we can all afford it.

Yeah, sure, we can probably go have a lot of steps without needing to work hard on it. Obviously, we cannot afford everything. Sharing the best practices, learning which tools are most valuable to our practices and how we can go and bring them to the practices has been a part of QCCA network.

Dr Schnell: Thank you very much. Got a couple more questions and we can probably then wrap it up. The next question is sort of a little hesitant to bring forward but I think I must. I work for the Community Oncology Alliance for a good bit of my time, and they championed the OCM program and now are engaged with ASCO on reinventing the wheel maybe but reaching into the Oncology Medical Home program.

It was discussed recently at the COA Conference, and it's there's a lot of buzz about this in the community as it goes into beta testing and in the real world. What do you think of that initiative? Is it of any interest to someone who's leading a fairly large network of clinically integrated practices? What do you think and what would you tell a broader audience?

Dr Blau: The fundamental concept of this model really aligns well with the work that QCCA does and the value-based care efforts of the membership. QCCA members have been already working on Oncology Medical Home program.

Even before the initiation of this program, we have our own tools and methodologies to look into it. I will say that we will continue our path and work around these initiatives and utilize our own pathways and other pathways.

Practices of QCCA are still independent practices, if they choose to bring a different tool or they're able to afford them and see value, but it's going to enhance what we're doing together as a clinically integrated network. It's all welcoming, of course.

Data benchmarking and pathways are important for us, and we're going to continue to build in a systematic way to provide this value-based care into our practices.

Dr Schnell: Thanks very much. It addressed exactly what I was asking. The next question is, how do you see the incorporation of value-based care into present and future programs and models focused on aggregating total cost of care, and specifically, whether you have any comments about bundled care in the day-to-day management and financing of oncology care moving forward?

Dr Blau: In an ideal scenario, the models for oncology would align to reduce administrative burden for practices. It's a long way. There is more than one idea out there. What I think is that doctors play a big role, and often forgotten in this discussion, all stakeholders, including and especially doctors, payers, and employers should have a seat at the table to discuss the best model.

This has to be all-around patient-centered care, and we need to figure out how we can maybe bring all these efforts into one vision and if we can align with this vision, I'm talking about all the stakeholders, then I think anything can be created out of it.

We have made a lot of progress with OCM, and other alternative payment models, hospital systems, academia, independent practices, big networks. Everyone has an idea on how this could be done. I think it's just bringing all these ideas together.

I'm all for bundles, actually, because we need to figure out how we can provide a care, it has to start from the best practices for the patient care, and hopefully grow out of it and we can build this together. Now it's going to take time, I don't think this is going to take months. I think it's going to take years probably. I think we're underway, hopefully.

Dr Schnell: Thank you. I'll end this session by saying thanks to my friend and colleague, Dr Blau, and will admit that I'm still at work in my spare moments, which there are a few, with a rural health clinic that's staffed by two wonderful oncologists in central Georgia.

I'm the third doctor and our leader who's about my son's age has made a personal decision to join the QCCA network. I'm working with him and with Dr Blau on a limited basis to foster some of the pathway developments. That's how we came to know each other some years back, and it's nice to rejoin that at this particular moment in time. Any other comments or questions, Sibel?

Dr Blau: I would like to thank you for the opportunity to talk about this topic. It's obviously very dear and near to my heart and all the members of QCCA. Thank you very much.

Dr Schnell: Thank you very much too. Lastly, I want to thank the audience, the viewing audience. These are meant not to be promotional, they're meant to be educational, and there's no better way to educate people with curbside discussions of this sort, and want to thank Dr. Blau and for the organizers for putting this together.

Hopefully, we'll be doing more of these in the coming months. It's a critical part of keeping people up to date with the things that are particularly involved in pathways and improvement in standardization of excellent care delivery across the cancer spectrum.