3 key insights from oncologists on issues affecting specialty care


Will Seaton

Essential Insights contributor, healthcare writer

Featured experts

Chadi Nabhan, MD, MBA, FACP

Chief Medical Officer, Cardinal Health Specialty Solutions

Jennifer Fillman

Vice President
General Manager
Specialty Services
Cardinal Health Specialty Solutions

Oncology care has never been more complex. The transition to value-based reimbursement and the increased demand for provable outcomes have created both challenges and opportunities for those working to advance cancer care.

To gain deeper insights into how these issues are viewed by providers nationally, Cardinal Specialty Solutions polled more than 170 oncologists, from a diverse mix of community and hospital-based practices across the country, as they met at three Specialty Solutions oncology summits earlier this year.

The in-depth survey report, 2017 Oncology Insights: Views on Reimbursement, Access and Data from Specialty Physicians Nationwide, shows the consensus (and apprehensions) around these important issues. Oncology Insights is the first in a series of research-based reports designed to deliver perspectives on key issues for specialty care providers, biopharma companies and other healthcare stakeholders.

Here are three key takeaways from the findings, which were released to coincide with the 2017 annual meeting of the American Society of Clinical Oncology (ASCO) in June.

1. Lack confidence in MACRA

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), now being implemented nationwide, was designed to help improve health outcomes and reduce costs by changing the reimbursement model of Medicare physicians to reward quality over quantity, as is currently incentivized by fee-for-service models. However, nearly nine out of ten of the oncologists (87 percent) surveyed are not confident MACRA will lead to better patient outcomes, and 86 percent are not confident MACRA will lower the total cost of care in the long run.

"What this shows is that many oncologists view increased administrative duties and reporting mandated by MACRA as a distraction from direct clinical care," said Dr. Chadi Nabhan, vice president and chief medical officer for Cardinal Health Specialty Solutions. "In addition, many oncologists question the link between lowering cost and improving outcomes." (For more information on MACRA, read “Risk and Reward with MACRA: The value-based wager that will transform healthcare reimbursement.")

At the same time, there are a number of oncologists who remain unsure about how they will comply with MACRA. The initial and long-term stages of MACRA will need to be carefully assessed in order to ease physician anxieties, support compliance with the reporting requirements, and determine its overall impact on care.


2. Strong interest in real-world evidence and patient-reported outcomes


While clinical trial efficacy and safety data have long been the primary source of information that oncologists use to make treatment decisions, there's an increasing desire to understand how treatments perform in real-world settings — especially since clinical trial participants tend to be healthier, younger, and more homogenous than the population at large.

Nearly three quarters (73 percent) of the oncologists surveyed feel that real-world evidence (RWE), like insurance claims data and clinical data from electronic health records, is important when making treatment decisions. Adding to this, RWE is likely to soon be more prominent, as the recently passed 21st Century Cures Act requires the Food & Drug Administration to develop a framework for the use of RWE in drug applications.

Oncologists have also become increasingly interested in patient-reported outcomes (PRO), which can give critical insight into factors like a patient's perceived quality of life, treatment satisfaction, and medication adherence. Seventy-six percent of oncologists now view those factors as important to treatment decisions, evidence of a larger trend that aims to place the patient at the center of care decisions. While the use of RWE and PRO thus far is limited and many providers still have skepticism about the reliability of this data, increased adoption in making treatment decisions from providers is expected in the coming years. (For more information on PRO, read "Patient-reported outcomes: a critcal piece in the value-based puzzle.")

3. Desire for improved patient support programs — and a larger role played by pharma companies


As patients, providers and caregivers are tasked with managing increasingly complex treatment regiments, patient support programs have become a critical part of specialty care efforts.

Such programs, which are generally funded by pharmaceutical manufacturers, can help patients by way of financial assistance, education, medication adherence programs, counseling, in-home visits, telephone support, or a variety of other services that aim to remove barriers to care.

As of now, 86 percent of the oncologists surveyed either somewhat or strongly agree that education and adherence programs can help improve patient outcomes in the management of chronic disease. Yet, oncologists said the availability and usefulness of such programs remain a challenge. 

"The physicians may feel this way for several reasons," said Jennifer Fillman, vice president and general manager of Cardinal Health Specialty Solutions. "Those include lack of awareness of the existence of these programs, lack of information on how to access these programs, or poor experience with these programs in the past."

More than 86 percent of oncologists say that pharmaceutical companies should play a larger role in financial support programs. In general, oncologists feel that the active promotion of these programs — either through sales, science liaisons, or direct-to-consumer marketing — will play a key role in increasing their use and efficacy.

The issues of changing reimbursement models, increased demand for provable outcomes, and desire for improved patient support programs may not have straightforward solutions. But it's clear that oncologists need more support and guidance in their quest to advance cancer care.

Explore the survey data

Transition to value-based care under MACRA

Emerging role of RWE and PRO

Importance of patient support services

2017 Oncology Insights:

Views on Reimbursement, Access and Data from Specialty Physicians Nationwide

Gain more exclusive insights into the views of oncologists nationwide on key industry issues.