Blog posts that are not press releases.
Cancer is one of the leading causes of death and disease in the U.S. Not only does cancer take an enormous toll on the health of patients and survivors—it also has a tremendous financial impact. Cost differences associated with oncology care in the community setting versus a hospital setting are significant with community oncology practices providing high quality, state-of-the-art care at lower costs to patients.
July 2016 marked the start of oncologists looking at a new way to manage cancer care with a shift from fee-for-service to value-based care, prompted by the launch of the Oncology Care Model (OCM) by the Center for Medicaid & Medicare Innovation (CMS Innovation Center). Today, CMS Innovation Center is expanding on this foundation with Oncology Care First (OCF)—a next-generation model that will phase out OCM and further emphasize the benefits of adopting value-based care models that favor care quality and outcomes over quantity of services provided.
Thanks to the success of OCM and other programs, the adoption of value-based care is advancing rapidly, delivering improvements in collaboration, costs and quality that oncology should embrace sooner rather than later.
Collaboration is one of the most critical components of value-based care. Enhanced coordination of care among healthcare providers can help improve patient outcomes and lower costs by decreasing unnecessary hospitalizations and eliminating emergency room visits.
Routine interdisciplinary care team meetings allow for enhanced collaboration and communication among members to ensure a patient’s needs are being met and timely follow-up is in place. This team-based approach assures the entire care team is focused on the same goals of care for each individual patient.
Because value-based care is still relatively new, it is important to discuss with clinical and non-clinical team members the specifics of the model and the importance of collaboration, as well as how it benefits the patient.
There are typically three main cost drivers facing oncology practices: hospitalizations, chemotherapy agents and variable resources. Driving down the costs associated with these drivers, while still providing top-shelf care, is essential to a successful transition to value-based care.
Education is a key component to effective implementation, and the primary focus in this case is the patient. Helping patients understand which symptoms of chemotherapy treatment merit a trip to the emergency room vs. an office visit with their oncologist or primary care physician can decrease unnecessary and costly ER visits. Strategies such as a “Call Us 1st” campaign can be an effective method to encourage patients to call their oncologist or physician first to see which route is better, assuming the situation isn’t life-threatening.
An effective triage system with nurses conducting proactive outreach to high-risk patients is another strategy that can deter the need for higher-cost interventions. Along those same lines, ensuring patients can always reach a live person by phone rather than having to leave a message—then worry about a call back—can also decrease costs associated with unnecessary emergency care.
Other cost containment resources include:
As important as collaboration and cost containment measures are to the success of a value-based care model, they cannot happen without a solid foundation of data. For example, participating in state health information exchange initiatives carries unique benefits in the value-based care environment, such as the ability to connect with laboratories to access test results in real-time or being able to see when or if a patient was admitted to or discharged from the hospital.
Comprehensive patient data allows oncologists to better evaluate treatment outcomes and determine what, if any, changes could be made to prevent ER visits or admissions. It can even provide the basis for deployment of advanced communications such as texting medication and appointment reminders.
The data challenge is two-fold: it requires the right technological foundation and the understanding of data and how to use it in practice transformation efforts.
To overcome these challenges, the American Oncology Network (AON) built a Value Based Care team that collaborates with physician champions to review data and make recommendations for continuous process improvements. The development of a quality care committee consisting of representatives from various departments who are champions of the value-based care model has also proven to be effective. This committee of peers can demonstrate the value of data in reducing costs while improving outcomes.
Transitioning to a value-based care model can be difficult and requires a level of infrastructure and manpower that many independent practices do not have—limitations that have forced some practices to pull back from its adoption.
However, partnering with a network such as AON can empower practices to embrace the potential of OCF. AON can provide the support and resources that set the stage for success in a value-based care environment. Among these are the technology and expertise to not only capture and share robust patient data, but also help transform hard-to-read metrics into action items.
Pharmacy services, care coordination, back-office support and a plethora of other tools are also available to AON practices to help them get—and stay—on the right track with value-based care.
While the model itself is relatively new to oncology, value-based care has already proven its effectiveness at improving patient care and driving down costs.
Value-based care isn’t going away. The sooner oncology practices embrace it, the sooner they will realize the many benefits it can deliver.
While cancers of the stomach and esophagus are rare, these cancers are usually advanced by the time they are detected. An expert medical oncologist sheds light on diagnosis, risk factors and treatment.
How are stomach and esophageal cancers diagnosed?
Patients diagnosed with esophageal cancer often start with concerns about difficulty or pain during swallowing, weight loss or a cough and hoarseness. Those diagnosed with stomach cancer often first notice a general discomfort in the stomach, loss of appetite, weight loss and vomiting. Screening generally includes an upper endoscopy, a procedure in which a thin scope with a light and camera is used to look inside the upper digestive tract.
Why do stomach and esophageal cancers occur?
Smoking, heavy alcohol consumption, and diets rich in fats and salt and lacking in fresh fruits and vegetables can lead to these cancers. Increasing age, gender (men are more likely to develop these cancers than women), obesity and lack of physical activity are also potential culprits.
Once diagnosed with stomach and esophageal cancer what are the treatment options?
Multimodality treatment (surgery, radiation and chemotherapy) is often used. Sequencing of treatment is determined by the stage, size and location of the tumor.
What types of surgeries are performed for stomach and esophageal cancer?
A process known as “endoscopic mucosal resection” removes the cancerous area through an endoscope. Subtotal gastrectomy, removal of part of the stomach, is used for cancer located in the upper part of the stomach. If the cancer has spread throughout the stomach, a total gastrectomy will remove the stomach and rework the digestive tract. For esophageal cancer, surgery may remove some or most of the esophagus through an esophagectomy.
How are radiation therapies used?
What is the best chemotherapy regimen for stomach and esophageal cancer?
Chemotherapy treatment options usually include between one and three drug combinations. The three-drug combination tends to induce the highest responses but also has the highest rates of side effects.
Why do some people have radiation therapy and chemotherapy while others just have chemotherapy?
Radiation therapy is used when cancer is localized to one area like the esophagus or stomach. When cancer spreads outside the local area to the liver or lungs it usually spreads through the blood. When this occurs, the cancer is no longer localized and other treatments are needed.
What are the benefits of adding chemotherapy to radiation therapy?
Adding chemotherapy to radiation therapy augments the effects of radiation therapy. Chemotherapy also helps control cancer cells that might be trying to escape into the blood. When given alone or in combination with radiation therapy, chemotherapy may help alleviate symptoms related to stomach cancer. In patients with more advanced stomach cancer in whom surgery is not possible, chemotherapy may also improve both the length and quality of life.
Targeted therapy offers a new hope for cancer patients and opens the door for the development of new treatment strategies for patients who carry certain genetic mutations in their tumors.
One condition treated effectively with targeted therapies is gastrointestinal stromal tumors (GIST), the most common type of sarcoma which occurs when abnormal cells grow in the gastrointestinal track. With July recognized as Sarcoma Awareness Month and July 13th as GIST Awareness Day, it’s the ideal time to draw attention to the growing body of evidence suggesting that GIST tumors—which don’t respond well to chemotherapy or radiation—can be treated effectively with targeted therapies such as tyrosine kinase inhibitors (TKIs).
All cells in the body are regulated by DNA that controls cell growth. Cancer cells typically have DNA mutations—changes in the normal DNA—that can cause rapid and unregulated growth of the cancer cells, leading tumors to grow and spread to various organs.
Specific mutations have been identified as main drivers for growth in GIST tumors. Targeted therapies combat these mutations by blocking the molecules that allow tumors to grow. TKIs can treat the tumors effectively or shrink them enough that surgery becomes an option. This approach precisely targets mutations that are predominantly present in cancer cells and offers a new way to control cancer cells without significantly affecting normal cells.
Our physicians at the Zangmeister Cancer Center strive to provide patients who have certain genetic mutations with access to clinical trials that include new targeted therapies. This is done by gathering information on the patient’s personal and family history of cancer. We then biopsy the tumor and send the tissue sample to a lab for genetic analysis. The results are then carefully reviewed to determine if targeted therapy—some of which are FDA approved while others are part of clinical trials—may be effective. This is an alternative to the more conventional “one-size-fits-all” approach to treatment and helps sidestep the cost and side effects associated with treatments that may not work on certain mutations.
This approach continues to evolve, and most likely will help increase the number of targetable mutations and available targeted therapies available to patients over the next years. This is an exciting time to be treating cancer, implementing new therapies that will lead to even more new tools for success.
At American Oncology Network (AON), patients are our top priority. We want to provide them with the best care possible throughout what is often the most stressful and scariest time of their life – and it is our physicians, nurses and employees that make that possible. That is why we strive to keep our team happy and safe, which currently means confronting the enormous challenges brought on by the COVID-19 pandemic.
Treating cancer patients is an incredibly essential service, and care continuity is a priority even in the face of COVID-19. Being there for our patients requires us to also be there for our employees by elevating internal wellness strategies.
Just days after the World Health Organization officially declared COVID-19 a pandemic, AON had assembled an emergency task force to map out a plan for keeping doctors, nurses and employees safe while still providing high-quality care to our patients, many of whom needed to continue receiving treatment.
The majority of our administrative employees transitioned to working remotely from home, armed with all the resources they needed to help create a secure, office-like environment. Our IT team accomplished this feat in about a week, and the outcome has proven positive: staff members who are telecommuting have maintained their normal levels of productivity with few exceptions.
The IT team also launched Telehealth services across all AON sites with over 5,200 telehealth visits completed since going live. This virtual care solution played a vital role in mitigating the spread of COVID-19 and keeping our providers, employees and patients safe.
For employees such as nurse practitioners who are patient-facing and therefore unable to work from home, safety was crucial to our strategy. In addition to providing sufficient personal protective equipment (PPE) such as gloves, gowns and masks, we also conducted training on proper handling and use.
AON also adheres to the social distancing guidelines set by the Centers for Disease Control and Prevention (CDC). Among these are spacing out appointment times and infusion chairs and screening all patients via questions on how they’re feeling, whether they have any COVID-like symptoms, where they’ve recently traveled, and if they’ve been exposed to anyone infected with the virus. In addition, employees are screened and their temperatures checked at the beginning and end of every shift. In addition to our daily cleaning services, our clinics also go through a deep clean once a week.
Because of our efficiency and ability to supply doctors, nurses and employees with the resources they need to be both safe and productive, AON was able to respond quickly to the pandemic and continue caring for our patients without interruption.
The COVID-19 pandemic is unprecedented and has been a challenging experience for everyone. We opted to modify our benefit offerings to include 10 days of paid emergency sick leave (ESL) to any full or part-time, and PRN employee who needs to be quarantined or who is caring for a loved one who has been infected with the virus. This provision is in addition to our regular leave policy and allows employees to receive their full pay either intermittently or continuously. We also offer an advance of up to 40 hours of paid time off (PTO) for anyone who runs out of ESL, and all employees have access to the Teladoc service through to the end of December regardless of their participation in the AON medical plan. In addition, employees enrolled in the medical plan will see 100% coverage of any COVID-19-related expenses that employees may incur, such as testing and co-pays.
We are aware the pandemic has created challenges that extend far beyond the workplace. With schools and most summer camps closed, AON is especially sensitive to employees with small children. We strive to be flexible and nimble with their schedules and are taking extra steps by compiling important information on childcare and other family-focused services. Emotional crisis support is also available to all employees regardless of whether they participate in AON’s benefits program.
To boost morale, our managers have come up with fun, creative activities such as virtual celebrations and trivia games for employees who are telecommuting. At our clinic in Baton Rouge, La., employees swapped recipes and created an e-cookbook that also features contributions from other practices in the AON network. We’ve also supplied lunch for employees who aren’t able to work from home.
AON recently surveyed employees to gauge the effectiveness of our COVID-19 provisions. The results were extremely positive – 81% were satisfied with our pandemic response and 87% were confident AON has taken the right precautions to minimize the impact of COVID-19. Additionally, 85% of employees working remotely said they had the necessary resources to maintain productivity.
At AON, our team members are heroes who have stepped up in times of crisis. It is up to us to make sure they are safe, comfortable and appreciated so they can continue carrying out the essential job of providing optimal care to our patients.
Breast cancer is most often associated with women, which is understandable as more than 276,000 women are expected to be diagnosed in 2020. Yet, breast cancer occurs in 1 of every 83 men and carries a 5% mortality rate.
Consequently, men need to be vigilant and educated about the symptoms and signs of breast cancer and should feel comfortable discussing them with their physician.
The clinical features of breast cancer in men are no different than they are in women. Symptoms include a lump or thickening in or near the breast or underneath an arm. A dimpling or puckering of the skin—known as peau d’orange—can also be a symptom, particularly of inflammatory breast cancer, and the nipple of the breast may be inverted. Another thing to look for is nipple secretion, which can be especially concerning if the drainage is blood.
No one is immune to cancer, but there are some factors that can heighten the risk of breast cancer in men, including exposure to radiation and a history of breast cancer in their family. An increase in a man’s estrogen level can also heighten the chances of breast cancer, so conditions such as Klinefelter’s syndrome and cirrhosis are risk factors. Transgender men using estrogen injections are also at an increased risk.
Like women, men should do routine self-examinations and check for thickening or lumps in the breasts. The best screening is a simple palpating of the tissue and checking in a mirror for any changes in the look of the breast’s skin or nipple. This should be done once a month, especially for men with a family history of cancer.
If any irregularities are noticed, reach out to a physician immediately. In the event of a tumor, the procedure for men is the same as women – a biopsy followed by a diagnosis, and then the decision whether to do surgery with or without chemotherapy or radiation therapy.
One of the biggest differences regarding breast cancer treatment in men and women is endocrine therapy. Aromatase inhibitors, which stop estrogen production in postmenopausal women, are used to treat women whereas men are typically treated with tamoxifen, which blocks the effects of estrogen in breast tissue. The reason for the difference is the insufficient amount of data supporting use of aromatase inhibitors to treat male breast cancer.
Cancer takes an emotional and mental toll on anyone it strikes. But because breast cancer is so strongly associated with women, men often face additional psychological challenges.
Some may feel their manhood is in question once they hear the diagnosis or they may become embarrassed by it. While stigmas are real and can be debilitating, the reality is that male and female breasts are made of the same tissue.
Consequently, psychological care is a big component of treating breast cancer in men, especially for patients with estrogen-receptor-positive cancer—the most common form of breast cancer wherein estrogen receptors on the surface of the cell bind to estrogen and enable the cancer to grow. In men, this means they are creating more estrogen than progesterone, which can make them feel like less of a man. Therefore, taking extra time to address stigma is an extremely important element of care.
Scarring is another concern. Reconstructive plastic surgery isn’t offered for men who undergo surgery to treat breast cancer, so it is important to remind male patients that the scar does not make them less of a person. In fact, the scar should be looked at as a symbol of the surgery that may have saved their life.
In tandem with the multitude of female-driven support systems in place for women, such as the saturation of pink every October to mark Breast Cancer Awareness Month, there are also good resources for men battling breast cancer.
The Male Breast Cancer Coalition and the Young Survival Coalition are helpful resources offering information about male breast cancer, as well as hotlines and support groups.
It is important to remember that cancer can happen to anyone – and while breast cancer in men is rare, it is real and can be deadly. As providers and oncologists, it is important that we recognize the physical and mental components of working with male breast cancer patients and provide the support systems that deliver optimal care outcomes.
The COVID-19 pandemic has negatively impacted industries worldwide, and healthcare has not been immune. Oncology practices in particular are looking to recoup dollars lost to a decline in patient visits and, as the economy weakens and unemployment rises, patients are looking for financial assistance and relief from high-cost medications.
The current environment could lead to a spike in biosimilar use, which can increase economic efficiency without sacrificing patient safety and satisfaction. But oncology practices should not view biosimilars as just a temporary alternative. Rather, these options could become part of the ongoing strategy long after the intensity of the pandemic wanes and the economy rights itself.
And while they offer plenty of advantages for practices and patients, working with biosimilars can be complex and may require the need of a partner to help streamline the process.
The biggest advantage of biosimilars is the savings, with some priced at 20% to 40% lower than the existing reference product. Those prices will continue to decrease as the market becomes more saturated, increasing competition.
Biosimilars go through a different regulatory pathway to demonstrate similarity to a reference product. The FDA’s determination of biosimilarity is based on the totality of the evidence, which includes an extensive analytical comparison to show that the proposed biosimilar and reference products are highly similar in structure and function. Animal, human pharmacologic, immunologic and additional clinical data are added as needed to the analytical data in a stepwise fashion. This allows for a shorter approval time and lower costs to develop a product with no meaningful clinical difference.
Consequently, oncologists can trust that there is no drop in the effectiveness and safety of the biosimilar drug while realizing the cost advantages for both the practice and patients.
Economically, oncologists benefit because the reimbursement for biosimilars is based on the average sales price plus 6% of the reference product, leading to small incremental profits for the practice. Because biosimilars are cheaper in cost, that eventually leads to savings on out-of-pocket costs for the patient.
While working with biosimilars can yield positive results, they also come with their own set of complexities that some independent practices may not have the bandwidth or expertise to handle.
Payer formularies vary widely as they relate to biosimilars. While one insurer may approve one biosimilar for specific indications, another may use a different one. Keeping up with these formulary variances is a daunting task for the average resource-strapped oncology practice; many either avoid using biosimilars or find themselves stuck in the administrative back and forth of claims denials.
American Oncology Network (AON) improves this outlook for its practice network through management and oversight of approved biosimilars. Our team keeps physicians current on formularies by insurer, streamlining processes and improving cash flow for practices and patients alike.
In addition, AON offers better buying and negotiating power, which leads to the purchase of more economical biosimilars. From an operational standpoint, AON alleviates a practice’s operational burdens by taking care of the drug purchasing and contracts.
If patients are wary about biosimilars, AON’s board-certified oncology pharmacists can assist in putting their minds at ease. Many independent practices lack the resources or manpower to create promotional collateral, instead relying on materials provided by the manufacturer—many of whom have had to shut down promotional departments due to COVID-19. AON can help educate patients on biosimilars with informative literature that is thorough but also written on a level that consumers can easily digest.
Cancer patients are dealing with enough stress – the last thing they need to do is worry about the safety and efficacy of their medications. Our team ensures patients know that biosimilars have the same potency, purity and safety as the reference medications.
The current global pandemic has underscored the clinical and financial advantages of biosimilars. Oncology practices should also consider how they may benefit from their use after the COVID-19 crisis is over.
By leaning on established networks such as AON to ease administrative burdens associated with using biosimilars, oncology practices can realize the benefits of expanded options for themselves and the patients in their care.
With COVID-19 on the forefront of everyone’s mind, it is difficult to remember that the decade started out with an uplifting headline in cancer care: the largest single year drop in cancer mortality. We also saw emergence of the next generation oncology model, Oncology Care First (OCF), which comes on the heels of a successful first-of-its-kind model, the Oncology Care Model (OCM).
As you shuffle through the countless articles, studies, and theories, there are many factors that play into the reduction in cancer deaths, many associated with science, demographics, society, and a change in the delivery of healthcare. Regardless of why, the news is a welcome development at a time when the nation is in the midst of a pandemic that continues governing our lives.
I am fortunate to be a frontline witness to one of the best stories in cancer care to hit our inboxes, thanks to my role within American Oncology Network (AON), one of the fastest growing oncology networks in the nation. I am charged with protecting community oncology by securing funding through revenue cycle processes. However—and more importantly—my role challenges me to think about how cancer care is constantly changing in our drive for better outcomes, enhanced delivery methods, lower costs, and a focus on value, which in turn requires that we challenge the “norm” of reimbursement methodologies.
Since its inception in 2018, AON has helped lead the charge to create new methodologies through key payer partnerships such as with the Center for Medicare & Medicaid Innovation (CMS Innovation Center) and its Oncology Care Model (OCM). This commitment to change has helped drive AON’s growth. For example, its involvement with OCM was an important factor behind the decision by Genesis Cancer Center—which has been part of OCM since the initiative began in 2016—to partner with our network.
Born out of a group of seasoned oncology professionals seeking to create a first-of-its-kind oncology focused value-based model, AON ensures that its practices have a seat at the table to participate in models with the potential to transform cancer care. This includes the OCM, which permitted oncology providers to improve health outcomes for cancer patients through specific reimbursement methodologies that reward value over volume. And, as its network proliferates, the AON philosophy provides its oncology partners with the flexibility to change with emerging methodologies such as Oncology Care First (OCF), introduced by CMS Innovation Center in late 2019.
As AON develops an oncology network that, while geographically diverse, is interconnected through a rapidly growing dichotomy of oncologists and a cancer team focused on building an infrastructure to support declining cancer rates, partnerships and advanced reimbursement methodologies like the OCF are key. Payment models are complex, and the most critical part of these models permits the autonomous delivery of cancer treatments and support services—something AON continuously promotes among our local care teams.
So now the question is whether there is a correlation between the adoption of a first-of-its-kind oncology focused payment reform model and the historic decline in cancer mortality rates. Within this next payment model, it is proposed that physicians who participate in OCF will still have the freedom to manage patient care and run their practices as they see fit. However, with OCF, they have better access to a pool of data from OCM that can guide clinical and administrative decisions and connect any dots between the model and outcome trends.
With this next generation of reimbursement, AON’s focus is on infrastructure development to support the balance between the various elements that consumers expect: value, outcomes, accuracy and timeliness. All of which is more important than ever. The network’s model is positioned to support this shift in attention as we can deliver the administrative expertise, infrastructure, and economies of scale necessary to optimize the transition to value-based care initiatives like OCF.
OCF has great potential to be a win for independent practices, their physicians and, most importantly, their patients. This is particularly true for those that partner with networks like AON. Doing so not only streamlines participation in initiatives like OCF with access to administrative expertise and the technology required for data collection requirements, but it also helps optimize involvement by offering turnkey access to newly covered benefits like extended care services in areas such as nutrition, anxiety and depression.
Most importantly, it is a partnership that puts them on solid footing for the future by reducing costs and improving quality of care—without sacrificing their clinical autonomy.
May is National Cancer Research Awareness Month and the ideal time to explore the crucial role clinical trials play in the field of oncology. Thanks to ongoing research and discovery, the industry has witnessed a host of medical breakthroughs, including development of new medications and therapies that can advance cancer treatments and help better the lives of cancer patients.
Community-based research offers a notable advantage to smaller, independent practices primarily due to one factor: patients do not have to travel far to participate in a clinical trial, which can boost enrollment and advance scientific knowledge.
While this helps practices overcome one of the greatest hurdles to getting clinical trials off the ground, they must still be well-prepared and properly equipped before moving forward—and most will benefit from a partner capable of streamlining their efforts.
Conducting clinical trials, whether in a lab or a small practice, is not for the faint of heart. First, physician groups need to catch the eye of clinical trial sponsors, who tend to gravitate toward larger practices with more expansive patient pools. The best way to do this is through a proven track record, which of course requires successful completion of at least one study.
Training and education are also required. Physicians and research professionals interested in running a clinical trial must undergo mandated training through the FDA’s Office of Good Clinical Practice (OGCP), which must be updated on a regular basis. And though not required, it is important that clinic staff on both the administration and clinical sides of the house be educated on the nuances of conducting a trial. This will help ensure compliance with required protocols.
Also, while many clinical trials have similar administrative requirements, oncology-focused research is unique because patients are facing a life-threatening illness. Not only is it more difficult to identify the right pool of potential participants, it also requires the right tools and extra time to ensure they are fully informed and able to make educated decisions about their involvement.
Through consent forms and in-person meetings, physicians need to work one-on-one with the patients to outline clinical protocols, risks, and benefits of the trial. It’s important for patients to understand that they are under no obligation to take part in any clinical trial and can withdraw at any time and for any reason. This is true for any trial – but because oncology trials involve severe and life-threatening illness, it is especially important to be candid and thorough with cancer patients.
Practices should also be prepared to dedicate additional resources for the increased administrative tasks, particularly patient-related documentation and record-keeping that accompany clinical trials.
Partnering with a network such as the American Oncology Network (AON) can streamline the clinical trial process, making it possible for independent practices to play a role in advancing cancer therapies. We not only support the heavy lifting on the administrative side, but also supply expertise and technology to help practices host more complex and, ultimately, more successful trials. For example, we bring to the table the equipment necessary to assist with blood and tissue sampling and testing, which allows practices to carry out certain trials that would otherwise be out of reach.
One of our most unique assets to a practice, however, is the ability to take a patient’s molecular characteristics and match them with a specific clinical trial. We use technology to help us identify those patients that match a study’s criteria and would potentially benefit most from participating. For example, use of EHRs and other systems enables us to match patients with trials based on criteria such as molecular defects or a change in tumor type.
Through AON’s streamlining efforts, we can help practices conduct their own trials, regardless of size, and help build their research programs. When it comes to community trials, working with AON provides access to over 35 years of expertise to assist in this area.
We also offer a high level of flexibility that lets us support practices engaged with clinical trials when the unexpected happens, like the current pandemic. COVID-19 has put a temporary hold on enrollment for some trials because of an inability to supply certain drugs, while others have paused their trials because patients aren’t able to travel or come in for regular lab work and other assessments required in all trials.
At AON, however, many of our trials are still up and running because they can operate remotely. Physicians and clinical trial coordinators within practices can securely access patient records and meet with trial participants via telehealth. Through the pandemic, we have worked closely with our research partners to make sure they can continue all required monitoring of our research through secure remote access.
Community-based clinical trials come with many benefits for independent practices. They enable patients to be matched with potentially life-saving research while staying within the comfort and familiarity of their oncologist’s office. Because this can accelerate enrollment, community-based trials often yield faster results—helping to move the science forward.
But running clinical trials can be an arduous and resource-intensive process. A network like AON, with its technology and decades of experience, can help streamline the process, putting clinical trial work within reach of even the smallest practices.
Providers may have collectively breathed a sigh of relief when the U.S. Department of Health & Human Services (HHS) extended the deadline for complying with new interoperability regulations. However, relaxing enforcement does not lessen the urgency around ensuring the secure exchange of and access to patient information.
In the field of oncology, interoperability is especially critical as access to comprehensive data not only impacts direct patient care, but also the clinical research that leads to life-saving treatment breakthroughs. Without the ability to share patient information across different channels, little progress can be made in our approach to cancer.
In early March, HHS released two wide-ranging Final Rules around interoperability – one each from The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS). These rules direct implementation of interoperability provisions spelled out in the 21st Century Cares Act to promote data exchange between providers and ensure patients can access their medical and claims information through application programming interfaces (APIs).
In April, the decision was made to extend compliance deadlines and relax enforcement for six months. As a result, providers have until November to comply with the ONC’s interoperability and information blocking rule, and implementation of CMS’s provisions for sharing admission, discharge and transfer notifications by Medicare providers goes into effect in spring 2021.
Even with the delay, the pressure on healthcare organizations across the board to step up their interoperability game remains intense. And for good reason: Having secure access to comprehensive patient information whenever and wherever it is needed is foundational to advancing the industry’s performance goals related to everything from quality of care and clinician workflow to population health strategies and scientific advances.
When it comes to interoperability, the seemingly insurmountable challenge for many small, independent oncology practices is the significant resource commitment required to update technology, build interfaces and ensure security. Even developing policies and procedures to guide data sharing and use can consume resources many small practices simply cannot spare.
This is where the right partner can make a huge difference. At American Oncology Network (AON), we have our own integration team to take the burden off our practices’ internal resources. Our team is able to install/upgrade and create the necessary interfaces quickly to ensure the secure flow of data between practices, hospitals, labs, pharmacies and other organizations within our network and each practice’s region—all guided by prevailing best practices to ensure optimal outcomes.
Our streamlined, scalable resources help advance interoperability and put critical patient data at clinicians’ fingertips, helping to drive improvements in patient care and clinician workflows. It also gives our practices a significant competitive edge in the market.
More comprehensive patient data naturally informs better diagnostic and treatment decisions. It allows clinicians to closely monitor the effectiveness of drug therapies and allows for a more tailored approach to care, which can lead to better outcomes. On the research side, the ability to securely share deidentified patient data with AON’s research partners supports advances in cancer drugs and other therapies.
Interoperability also helps improve the way we practice medicine by streamlining workflows. The ability to access comprehensive and current patient information in one place, including histories, lab results and demographics, saves a tremendous amount of time that can instead be spent on actual patient care.
Interoperability will undoubtedly remain an industry priority for the foreseeable future. While forward progress has been made, we have a long way to go before achieving full, meaningful interoperability. The guidance provided by ONC and CMS helps, as does seeing the benefits of broader data sharing firsthand.
We are currently dealing with an unprecedented explosion in the volume of data, and we are seeing a monthly increase in research, outcomes information, lab tests and drug development. The ability of healthcare organizations to analyze this data on the fly will soon become critical.
The rapid advancement of technologies like artificial intelligence and machine learning will soon translate into even diagnostic support tools for physicians, adding further urgency to finding ways to deliver health information in an easily digestible manner. Meaningful aggregation of data is an absolute necessity, but it cannot happen without strong interoperability and collaboration between systems, healthcare organizations and government.
Overcoming cost and resource barriers by partnering with a network like AON can help independent oncology practices realize those benefits faster—and more economically—than they can on their own. The key is experienced implementation teams, economies of scale and a commitment to ensuring clinicians can focus on the patient, not the technology.
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