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NCCN Academy Explores Pressing Issues in Oncology Today

By Sherry L. Ulrich, MBA, Market Insights Specialist

On July 17, 2014, the National Comprehensive Cancer Network® (NCCN®) hosted the NCCN Academy for Excellence & Leadership in Oncology™ School of Pharmaceutical & Biotech Business at the Rittenhouse Hotel in Philadelphia, Pennsylvania. The event, moderated by Clifford Goodman, PhD, of The Lewin Group, provided an educational forum for pharmaceutical and biotech professionals to participate in and observe interactions with key stakeholders surrounding key business, policy, coverage, reimbursement, informational, and operational issues in oncology, while gathering valuable insights into developing effective strategies for navigating the various constituencies involved in cancer care.

The July Academy featured three modules covering a broad range of oncology topics including, but not limited to NCCN Member Institution best practices for changes in strategy and care delivery; the effect of health care reform on access to innovation in cancer treatment; and an overview of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) processes.

Following opening remarks from Gary J. Weyhmuller, MBA, SPHR, Chief Operating Officer, NCCN, the first module, How the Affordable Care Act (ACA) is Affecting NCCN Member Institutions: A Discussion with NCCN Best Practices Committee Members and Leadership on Changes in Strategies and Care Delivery, included the following panel of best practices experts from NCCN Member Institutions: Edward J. Benz, Jr, MD, Dana-Farber/Brigham and Women’s Cancer Center; Shirley A. Johnson, RN, MS, MBA, City of Hope Comprehensive Cancer Center; Maureen Kelly, RN, MS, OCN, NEA-BC, Roswell Park Cancer Institute; W. Thomas Purcell, MD, MBA, University of Colorado Cancer Center; and Warren Smedley, MSHA, University of Alabama at Birmingham Comprehensive Cancer Center.

The panel discussed varying experiences based on whether or not their respective states have adopted any changes since the implementation of the ACA, stating that socioeconomic, geographic, and demographic variables also impact strategies of care delivery. The narrowing of networks, the panelists observed, has had a profound effect on academic cancer organizations—with the shift in site of care, patients are not always able to access care at academic cancer centers outside of their state exchanges. Adding further complication is the potential inability for patients with rare cancers to receive care from a specialist who focuses on their type of cancer.

Panelists expressed concern over unintended consequences of pathways implementation, stating that strict observance of pathways can stifle effective treatment approaches, potentially resulting in a higher frequency of emergency care and, ultimately, higher priced care. To address these concerns, the panel also discussed ways in which academic cancer centers can demonstrate value, including through collaborations with payers, process improvement, removing economic barriers to clinical trials, and defining and measuring the right outcomes. Panelists agreed there is a need for patient education partnerships and access to those resources in order to enhance patient education as health literacy in the United States is lacking, even among patients who may be considered well-educated. 

The day’s second module, Health Plans and PBMs in the Exchanges—Approaches to Coverage for Cancer Treatment and the Effect ACA is Having on Access to Innovation, was co-facilitated by Xcenda, LLC and included the following panelists: Amanda Forys, MSPH, Xcenda, LLC; Allan Kogan, MD, Humana; Kara Suter, MS, Vermont Health Access; and Howard Wild, BS Pharm, RPh, MedImpact. The panel discussed the need for increasing engagement with patients, the increasing financial impact of health care on patients, and the impact on the patient’s ability to make choices.  As the financial impact increases, so too does the responsibility and accountability of providers to understand and choose the better “value” in each of the treatment options in order to help their patients with the decision-making process.

The performance of the exchanges, as well as the implementation of health plans and pharmaceutical benefit management, is ultimately going to affect innovation, according to the panel. In the age of biomarkers and targeted therapies, treatment plans are reliant on innovation. Payers are not looking for “me too” drugs, said the panelists.  Furthermore, the payer’s willingness—or unwillingness—to pay for innovative drugs will have a definite impact on the standard of care. They indicated more willingness to pay for drugs that demonstrate value through data, and noted a need for additional quality sources to aid in decision making.

The final module of the day, Meet the NCCN Guidelines Experts—A Discussion of Guideline Changes Including the Inclusion of Cost, Biomarkers, Survivorship, and Recommendations for the Development of Relevant Clinical Trials, included perspectives on development of the Guidelines®. Panelists included Robert W. Carlson, MD, NCCN; Toni K. Choueiri, MD, Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center; Crystal S. Denlinger, MD, FACP, Fox Chase Cancer Center; Robert J. Morgan, Jr., MD, City of Hope Comprehensive Cancer Center; Gregory A. Otterson, MD, The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute; and Alan P. Venook, MD, UCSF Helen Diller Family Comprehensive Cancer Center.

The panel discussed items including, but not limited to the types and levels of data for submission to the NCCN Guidelines panels, biomarkers and clinical trials, transparency, and survivorship.  There was also a discussion regarding value, as it pertains to outcomes, such as overall surveillance and progression-free survival, as well as the significance of true patient-reported outcomes, and how these factors are considered when making decisions for the NCCN Guidelines.  Finally, it was noted that while each NCCN Guidelines panel has its tumor-related nuances, there is work being done towards creating consistency regarding items, such as inclusion of patient advocates.

The next NCCN Academy will be held Wednesday, March 11, 2015, in Hollywood, Florida, in conjunction with the NCCN 20th Annual Conference: Advancing the Standard of Cancer Care™.  For more information about NCCN Academy for Excellence and Leadership in Oncology™ School of Pharmaceutical and Biotech Business, visit NCCN.org/academy.