Working with Integrated Health Delivery Systems in Cancer Care Ecosystem

Conference Correspondent - AVBCC 2019 Summit


At the first of the pre-summit professional development workshops, AVBCC Co-Founder and Chairman, Burt Zweigenhaft, BS, Managing Partner, Upstream Partners, took a few moments to introduce the meeting co-chairs and to open the day’s business. Mr Zweigenhaft emphasized that the AVBCC Summit is uniquely concerned with bringing all stakeholders together at one annual meeting where it is possible to learn a great deal from a variety of perspectives. He framed the goal for these special pre-summit panels and discussions as an opportunity to “take a deep dive” into the subject matter, to be interactive, to ask questions, and to network.

To gain the most benefit from the assembled expert opinions and differing professional affiliations, the first session was meant to bring one important aspect of value-based care into focus, that is, the system of integrated delivery of medical services in the oncology space, often referred to as IDNs (integrated delivery networks). The moderator, Barry Brooks, MD, Medical Director and Chairman, The US Oncology Network P&T Committee, McKesson Specialty Health, began by suggesting that the term IDN itself is ambiguous and not that well understood. He remarked that it is a struggle to describe and articulate exactly what an integrated delivery system is and how it operates.

Panelist John Sprandio, MD, FACP, Chief Physician, Consultants in Medical Oncology and Hematology, a community-based medical oncologist and a member of the US Oncology Network, stated that, in actuality, IDNs range in size and scope from large National Cancer Institute–recognized physicians and cancer centers to independent community-based networks. However, despite their differences, their shared overall aim is “to keep people out of the emergency room and hospital and to keep them healthy.”

“If you’ve seen 1 IDN, you’ve seen 1 IDN,” stated Niesha Griffith, RPh, MS, FASHP, Advising Partner, McGivney Global Advisors, underscoring what could be interpreted as ambiguity, but is a reflection of the greatly varying social and geographic dimensions—from very rural to densely urban—of healthcare delivery.

Dr Brooks then posed the provocative question: How do all these integrated payer options bring value? He invited the panelists to share their views.

The real questions, the panelists responded, are: what is value and value for whom? After all, each stakeholder will have different definitions and metrics for “value.”

One objective, said Ms Griffith, is to bring value to patients by making chemotherapy more convenient or easier to obtain, “bringing care to a community is important; which [therapy] people choose might be dependent on whether they want to travel” to a distant cancer center in a less rural area. Tara Herington, RN, Vice President, Cardinal Health, agreed with this, saying, “distance is a huge barrier, and fundamental or tactical things become barriers too.” Food, lodging, transportation, provisions for a partner or caregiver are important considerations. Programs such as Patient Support that remove barriers add value for patients.

Speaking from the perspective of what he described as a “perfect IDN,” Robert Hauser, PharmD, PhD, Vice President, Clinical Analytics, Cancer Treatment Centers of America (CTCA), explained that CTCA has been a “patient-centric” organization from its beginnings. He explained that an IDN such as CTCA creates value because it allows patients to receive all services in one place; it integrates technology; and coordinates care across the continuum. Data that are collected in the process permit continuous quality improvement. Although it is initially expensive to invest in the technology to implement such a system, it ultimately brings down the cost of care.

The panelists were unanimous in their assessment that electronic medical records have been crucial for integrating systems and coordinating care, and creating value, although there is tremendous variety between sites. In the end, said Dr Brooks, the moderator, what will be needed is “cultural buy-in” across the board to fully realize the value of IDNs.