Q&A: Cancer Needs a Better Roadmap
Rapid advances in oncology have sometimes made treatment paths more uncertain. Payers and providers can join forces to fix that.
Breakthroughs in cancer treatment are a bright spot in 21st-century medicine, with mortality rates decreasing by 1.5 percent every year for the past two decades.
Last year, Roger Brito, an oncologist and the Divisional Head of Enterprise Oncology at CVS Health, helped launch the Transform Oncology Care program, which aims to use new technology to advance outcomes for oncology patients, their physicians and payers.
The program is being rolled out nationwide to health plans that contract with CVS Health and for purchase to nonmember provider systems. We asked Brito to discuss the new tools and how else providers can tackle the “triple toxicity” of cancer.
Question (Q): Looking at the oncology landscape, what’s going well and where is there need for improvement?
Brito: The field is always changing. Most oncologists are treating patients with completely different therapies than they were five years ago. The good news is that technology is driving innovation and improvement, and the majority of cancers, when diagnosed early, can be effectively managed, treated and even cured.
But this rapid rate of innovation can be a challenge. Today, the majority of cancer patients are treated in community health care settings, not at big academic centers. And local oncologists often don’t have the luxury of consulting with a broad team of specialist colleagues. Due to time constraints, it can be difficult to keep pace with evidence-based care guidelines. I know that from experience — I’ve practiced in both academic and community settings. So, there’s a need to streamline all the changes, educate providers and align with best practices.
Q: You were one of the forces behind the “Transform Oncology Care” program from CVS Health. What are some of its guiding ideas?
Brito: The question first posed to our team was straightforward: “How do you fix cancer care?” We found that cancer patients are likely to experience what we call “triple toxicity.” Of course, there’s a physical toxicity of treatments, like chemotherapy. But there can also be financial toxicity, because of out-of-pocket costs, and there’s another toxicity from the psychosocial effects of having cancer. We looked for ways to target all three, to treat cancers more effectively while also reducing the total costs of care, keeping in mind that it’s the patient at the heart of this care that we should be thinking about first and foremost.
Q: One of those steps has been a partnership with the National Comprehensive Cancer Network (NCCN). How does that work?
Brito: One solution for smarter, more effective care is to give these local oncologists a set of digital tools that gives them better access to cutting-edge, promising therapies. That better care management leads to savings, because of fewer trips to the emergency room or hospital admissions.
The NCCN treatment and supportive care guidelines, which cover more than 97 percent of cancers, are there to assure that a provider is making the best, evidence-based choice. The guidelines are regularly updated, resulting in more than 500 changes annually. It can be difficult and time consuming for oncologists to keep pace with new recommendations — in fact, we know that only one in seven community oncologists regularly consult these care pathways.
So we’ve partnered with NCCN to integrate their treatment guidelines directly into our web-based provider portal. This is truly a novel approach. The platform allows participating oncologists around the country to have at their fingertips the most up-to-date NCCN clinical guidelines and therapy regimens at diagnosis. They no longer need to worry about researching 500 updates. We provide that information to them in real time at their point of prescribing, which easily fits into their workflows.
Therapeutic regimens that align with the NCCN guidelines will also automatically receive prior authorization approval, speeding therapy for patients. In the past, that approval process could take up to a week to complete.
Q: Your team has also spearheaded a move toward broad-panel genomic testing. Why is that important?
Brito: With more advanced cancers, the NCCN guidelines can include a number of treatment options, compared to just one or two recommendations for early cancers. Precision medicine — mapping an advanced cancer to a specific genetic mutation — can deliver improved survival.
One problem is many patients with advanced cancers don’t get genetic sequencing, or if they do, it’s too narrow or it’s too late to benefit from the drug. And we know about one in seven oncologists don’t order these tests for a variety of reasons, including the fact there are relatively few payers who reimburse broad-panel sequencing.
Broad-panel tests identify more individual variations in a cancer, which in turn allows oncologists to pinpoint the best treatment more quickly. That can eliminate the need for second and third rounds of alternative therapies. So our program is increasing access to this testing for eligible patients, with the platform automatically flagging those who would benefit.
We recently completed a study with cancer patients who received treatment based on broad-panel versus narrow-panel sequencing, and total care costs were cut by almost half six months out. Broad-panel costs more up front, but total costs were lower since the testing allowed for more targeted interventions and improved outcomes.
Q: An early version of Transform Oncology Care has been piloted across 12 states for patients in CVS Health provider networks. What has the evidence shown?
Brito: The vast majority — over 90 percent — of our 600-plus providers delivered cancer care to their patients based on NCCN best practices. The trend we’ve seen is an improvement in the standard of care. While we’re still accruing and analyzing data, there’s evidence of fewer hospitalizations and chemotherapy treatments, improving care, saving money and lessening the burden of side effects.
For me, that is incredibly promising. We’re bringing greater alignment between providers and payers, promoting high-quality care at lower costs. It’s the guide star of value-based care, that providers aren’t getting reimbursed for doing things to the patient, but for doing things for the patient. The patient benefits from better treatment at a lower cost. That should be the goal for all of us.