Supergroups: Sharing the Burden Put on Independent Oncology Practices
Orlando, FL—With many external pressures being put on independent oncology practices, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation, 340B drug pricing, site-neutrality issues creating disparity, US Pharmacopeia Convention (USP) 797 and USP 800 guidelines, and quality reporting, oncology practices are struggling to bear the weight independently, and a team approach is more vital than ever. As a result, the allure of becoming part of a supergroup is hard to deny, said 2 presenters at ASCO’s first Oncology Practice Conference in March 2017.
Ray D. Page, DO, PhD, FACOI, President and Director of Research, The Center for Cancer and Blood Disorders, Fort Worth, TX, and Barbara L. McAneny, MD, MACP, FASCO, Chief Executive Officer, New Mexico Oncology Hematology Consultants, and Chair, National Cancer Care Alliance (NCCA), discussed this topic based on their own experience within their community oncology practices.
Community oncology practices have responded to mounting pressures by merging, consolidating, and closing practices; pursuing academic and institutional affiliations and acquisitions; and creating supergroups that offer independent practices the ability to maintain a level of autonomy, while enjoying the benefits that come with being part of a larger medical team.
“Cancer care is now a team sport,” said Dr Page. “There is no ‘I’ in the Oncology Care Model. If we’re going to survive under this, we’re going to have to work and coordinate together as a team,” he added.
The Oncology Circle, a collaborative of best-in-class oncology practices from across the country, comprises approximately 30 practices that have historically shared practice data, and community oncologists have used that information to advance their practices over time.
“But now, we’re getting to a point where sharing data isn’t good enough. We need to share more robust cultural processes that go along with managing treatment nowadays,” said Dr Page.
Key strategic priorities common among supergroups include the identification and the dissemination of best practices in value-based care in oncology, sharing technology and informatics to formulate methodologies of clinical data aggregation, and strengthening collaboration in clinical research.
Members of these alliances typically seek to develop relevant educational programs for quality enhancement and revenue generation, develop new revenue-generating programs, and purchase drugs and equipment as a group. Another common priority is ensuring that the members of the supergroup remain in the top 25% of practices participating in the Merit-Based Incentive Payment System instituted by MACRA.
Building External Relationships
Dr Page emphasized the importance for oncology practices of building external relationships with different entities, such as clinical pathway and electronic health records (EHRs) vendors, clinical trials management, foundation support, actuarial data management, and society leadership in oncology.
“Be heavily engaged in societies. They’re there to help us gain collective knowledge and come up with solutions,” he said.
Dr Page also encouraged relationships with local, state, and national policymakers. “It’s extremely important for practice leaders to be proactive in shaping and writing policy, rather than keeping their heads in the sand and being reactive,” he said.
Join forces with like-minded groups, he advised. Dr Page is one of the founding members of the Quality Cancer Care Alliance (QCCA), an inclusive consortium of like-minded, independent community oncology practices with diverse stakeholders in the cancer community that are committed to leveraging their combined knowledge and experience to improve patient outcomes and cancer care delivery. QCCA comprises 14 practices in the United States.
As a result of these collaborative efforts, Dr Page and his colleagues have seen early achievements, including triage pathways to support patient-centered care, Six Sigma training for employees, the establishment of a research network, and several emerging clinical trials.
In addition, the team was able to pull together pertinent practice data to effectively argue the detrimental economic impact of the Medicare Part B demonstration project, and to move up the reporting time period for quality benchmarks that Dr Page called “oppressive.”
Furthermore, Dr Page and his team performed risk stratification analyses on practice EHR data to identify high-risk patients in real time, improved group purchasing organization (GPO) negotiations, and launched a smartphone-based oral chemotherapy adherence and toxicity monitoring program and a “virtual scribe” pilot to save physicians from spending hours in the evening catching up on paperwork.
The National Cancer Care Alliance
“A lot of us don’t work with friendly hospitals that want us [to] do better,” said Dr McAneny. “For many of us, our hospitals just want to make us part of what they’re doing,” she added.
The independent oncologists at her practice wanted to find a way to maintain their autonomy, said Dr McAneny. “Many of us value the ability to be a small practice that can be molded into what our community wants and needs,” she said. “But some things are going to require a bigger entity, and we decided that a group of practices would be able to come together and create this.”
The NCCA is such an entity. This nonexclusive, oncology physician membership organization allows practices, at their discretion, to take advantage of services, products, and participation in state-of-the-art clinical trials that would typically only be offered to very large, integrated health systems.
The NCCA achieves this by offering preferred pricing through its combined membership. It is organized by physicians, and reflects a supergroup of 220 oncologists in 16 practices across the United States, governed by 4 appointed board members, a 5-member management committee, and a 15-member leadership board.
In 2016, the NCCA developed a successful partnership program that allows pharmaceutical representatives to meet with multiple physician leaders at once. Through its GPO subcommittee, the NCCA began to examine economies of scale in terms of purchasing nonmedical supplies, and to pursue group purchasing whenever possible (ie, toner cartridges, insurance, and advertising). Through the work of its information technology subcommittee, the NCCA was able to poll all NCCA OncoEMR (electronic medical record) users to assemble a single request for system enhancements, issues, and improved system functionality, and to vet software vendors on behalf of all NCCA practices.
“EMR vendors are good at dealing with patients one at a time, but bad at letting you have all of your data at once if necessary (ie, dealing with local payers, pathway compliance, shipping to CancerLinQ),” said Dr McAneny. “We want to take that vendor relationship and say, ‘We’re a large group of your customers, and these are the things we need you to do,’ in hopes that they’ll recognize that ours is an important relationship,” she added.
Restructuring Clinical Trials
The NCCA clinical trials subcommittee is working with NantCRO and the QUILT/Cancer Moonshot 2020 program to expedite the opening of clinical trials. “We’re trying to figure out a way to implement a version of ‘TSA [Transportation Security Administration] Precheck’ for all practices,” Dr McAneny said.
“We don’t need pharma to look at standard operating procedures in a practice before every clinical trial. We want to be certified in a way that our data are trusted,” she added. Dr McAneny’s goal is to open clinical trials within 2 to 3 weeks rather than the common wait period of 6 months or more.
She emphasized the value of a collaborative approach to collecting clinical data. Providing pharmaceutical companies and other research entities with true outcomes data, such as actionable toxicity and cost, will offer a potential revenue stream for oncology practices, said Dr McAneny.