When the COVID-19 pandemic struck in early 2020, oncology was in the middle of a major transformation to value-based care. “The COVID disruption may not be an episodic disruption but a permanent change in the way we pursue value-based care,” said Bruce Feinberg, DO, Vice President and Chief Medical Officer, Cardinal Health Specialty Solutions, and the moderator of the Association for Value-Based Cancer Care August 26 webcast.
Practices across the country have met the challenges of operationalizing new systems and continuing to care for their patients, said Amy Valley, PharmD, Vice President of Clinical Strategy and Technology Solutions, Cardinal Health Specialty Solutions. “Who would have thought we would be doing alternate clinic days and dividing staff into separate teams? It has been amazing to watch the innovation.”
Dr Valley said that overall, aggregate data across Cardinal’s oncology practice network show that new patient visits declined by an average of 30% during the pandemic, with a lot of regional variability, and treatment visits declined by approximately 15%, with infusion impacted more significantly than oral. “We have seen a trend toward recovery but still not back to pre-pandemic levels,” she said.
Claim denials spiked in April and May, a trend that was partly driven by telehealth denials and a learning curve over the relaxation of restrictions on that practice, but there was also an increase in denials for regular visits. “The ship got rocked for a while, and I think the impact on practice and business office workflow might have played a role in these increased denials,” Dr Valley said.
An important topic in this webcast, as with many other sessions, was the long-term implications of the virtually overnight adoption of telemedicine into oncology practices.
William Mitchell, MD, CEO and Senior Partner, Southern Oncology Specialists, suggested that the biggest strength of telehealth is that it gives the patient the ability to have access to the office and clinicians without being physically there. “If your scan came out fine, you could talk about that with your doctor without having to come to the office and pay a copay,” he said. “But it doesn’t replace face-to-face discussions in situations that may not be optimal remotely, such as a change in scan or a recurrence, and it doesn’t replace physical exams when someone has a complaint.”
Going forward, telemedicine will likely be complementary to, rather than a replacement for, in-person visits, Dr Mitchell said. “Our practice has vertical integration, so our patients are more comfortable coming back to the office, knowing that they don’t need to also go to another location for ancillary services.”
Regarding COVID’s interruption of the pursuit of value-based cancer care, Sibel Blau, MD, President and CEO of Quality Cancer Care Alliance Network and Medical Director of the Oncology Division of Northwest Medical Specialties, said that her practice had found it necessary to change a number of workflows that had been created over several years. “We started our value-based care program about 5 years ago and built up a system with case management, patient care coordination, and all the supportive staff around it, including data analytics tools like the AI system Jvion,” she said. “COVID required us to change a lot of systems, including hiring more nurses and rebuilding our triage pathways. But although we have made a big shift in dealing with the pandemic, we still need to focus on value-based care.”
The value-based care model has also placed emphasis on increasing the role of advanced practice professionals (APPs) to improve practice efficiency, and in the COVID environment, they may also help practices at least maintain financial neutrality. “Even before COVID hit, we had hired 3 new physician assistants for our practice for things like chemotherapy education teaching. They have become an integral part of our practice,” said Dr Mitchell.
“We were also on an APP boom because of all the value-based care initiatives we had put in place,” said Dr Blau. “Our AI system watches the 30-day mortality rate, and we realized early on in the use of this system that we needed APPs not only to do palliative care visits for those patients, but also to work with sick or septic patients picked up by this tool giving us early signs of someone being in trouble.”
What if value-based care programs move to an episode-of-care model for reimbursement? Dr Mitchell and Dr Blau agreed that their practices were ready. “We have the infrastructure and we can designate value because our model is based on quality over cost,” Dr Mitchell said. “A lump payment gives us the opportunity to see how best to utilize our services to benefit the patient.”