By Robert Daly, MD
The ASCO Quality Care Symposium occurred this past week in Phoenix, AZ. The scorching Arizona sun shone a bright light on a variety of issues in cancer-care delivery including financial toxicity, care redesign and quality reporting in the age of the Oncology Care Model and MACRA, and patient engagement and patient-centered care.
While there were many talks that advanced the agenda of quality improvement, there are three not-to-miss lectures:
1. Presenter: Alex Jung, Partner, Ernst and Young/Parthenon Group
Title: American Patient First: Policy Overview of Trump Administration’s Drug Cost Policy Plan
If there were ever an industry that deserves to have the sun shone on it, it is the Pharmacy Benefit Management industry. Ms. Jung speaks from experience as a former forensic accountant, head of corporate strategy for Walgreens, and now partner at Ernst and Young/Parthenon Group. Ms. Jung is famous for coining the term “disintermediating the intermediary,” meaning getting rid of the middle man. Her talk provides a crisp overview of the four main policy pillars of the American Patients First Act: increasing competition, better negotiations, lowering list prices, and lowering out-of-pocket costs. She outlines many of the business practices occurring today that affect drug prices and access, such as pharmaceutical companies paying biosimilar manufacturers to delay the introduction of their products to market to protect the branded product’s market share. She also highlights the changes that this legislation can bring about, including ensuring that discounts and rebates that are paid by the drug company actually get to the patient and transparency in pricing for patients at the pharmacy counter. For those interested in health policy and drug pricing, Ms. Jung provided a remarkable 15-minute overview on this important legislation.
2. Presenter: Kathi Mooney, University of Utah
Title: Innovations in Care Delivery, Technology Assisted Outreach
Dr. Mooney kicked off this series of talks on innovation in care delivery with a discussion of the evolution and future direction of technology in cancer care. She posed the question: Should we re-think the brick-and-mortar approach to cancer care and instead provide care to patients when they need it and where they need it? Mooney notes the current brick-and-mortar model results in emergency room visits and unplanned hospitalizations but that through the use of remote monitoring, including through newer technologies such as passive sensors and chatbots (eg, “Alexa, what can I do for my nausea?”), we can provide targeted interventions in real time in the real world. Dr. Mooney proposes that the home is the next great frontier for cancer quality improvement and that technology will make this feasible.
3. Presenter: Thomas J. Smith, Johns Hopkins Medical Institutions
Title: Lessons Learned From Brushes With Serious Illness
Dr. Smith provided a very honest account of his experience with prostate cancer. Quoting Nessa Coyle, he noted that the diagnosis of any serious illness is an “existential slap.” In a powerful delivery that mixed humor with insight, Dr. Smith provided advice and eight tips for both providers and caregivers including:
- NavTip4: Go to a surgeon who shows you his or her results.
- NavTip6: Encouragement. “You are having a really tough time but hanging in there.” And, a hug.
I was inspired to take many of these tips with me into my next clinic encounter.
These are just three of many great talks by thought leaders in oncology care delivery. I encourage the community to access ASCO’s meeting library for more allocutions from Arizona.