Meadow Green co-wrote this post with Christina Corridon.
In addition to its coverage on value in cancer treatments, the 2016 American Society of Hematology (ASH) Annual Meeting also featured sessions that highlighted how players in a rapidly evolving healthcare delivery ecosystem can collaborate to deliver value and lower system costs.
One ASH session that focused on the evolution in healthcare delivery was “Best Practices for Incorporation of Nurse Practitioners, Physicians’ Assistants and Clinical Nurse Specialists Into Hematology Care,” which focused on ways in which these roles are becoming increasingly deeply embedded to deliver care both economically and sustainably. Models for the involvement of advanced practitioners vary, especially in academic settings in which nurse practitioners and physicians’ assistants fit into a wider constellation of providers, such as social workers, research coordinators, referring physicians, hematologists, nurse coordinators and pharmacists. In most cases, the physician will still complete the initial visit, patient workup and treatment selection, with nurse practitioners and physicians’ assistants spearheading patient management thereafter.
This model will continue to evolve as the demand for oncology visits is expected to increase by 48% by 2020, whereas supply will only rise by 14%, according to the session. In other words, if nurse practitioners and physicians’ assistants are not currently playing a large role in oncology care delivery in your region now, they likely will in the future.
The session entitled “Systems-Based Hematology: A New Career Path for Hematologists” also focused on system costs, quality and value. The session featured multiple hematologists sharing their experiences in how they were able to impact healthcare decisions system-wide. Two success stories demonstrate how guidelines and pre-set physician order entry systems—set forms that limit a drug order—helped address and prevent the off-label usage of expensive drugs that came from the Dana-Farber Cancer Institute and HealthPartners. In fact, HealthPartners reported that these order sets were able to reduce expenditures on the off-label use of recombinant factor VII—a drug used to manage bleeding—from $1 million to $200,000.
In the session “Why My System Supports a Systems-Based Hematologist,” Dr. Brian Rank, a medical director from HealthPartners, gave insight into the importance of engaging with hematologists on these types of initiatives from a systems perspective. HealthPartners is a payer/provider system, and its development trajectory was heavily influenced by the region in which it operates. In Minnesota, he explained, people “come together” on measurement, transparency and reporting, which has easily translated into reporting on affordability, quality metrics and the patient experience in healthcare. These affordability metrics point to the need for sustainability, especially since about 50% of HealthPartners’ covered lives are subject to a high deductible.
To address these long-term affordability and sustainability issues, HealthPartners has incorporated a partnership agreement and an essential reading list as part of the hiring process of more than 1,000 physicians, as well as leadership development, evaluation and performance management. According to Dr. Rank’s session, the partnership agreement includes an organizational commitment to provide and the tools to “ensure satisfying and sustainable practices,” in additon to a clinician agreement to “reduce unnecessary variation in care to support quality, reliability and customized care.” Notably, this focus on reducing variability and controlling costs does not come at the price of physician autonomy or satisfaction. In fact, HealthPartners’ average ranking in the American Medical Group Association’s physician satisfaction survey has improved from 2005 to 2015.
What does all of this mean for manufacturers? It certainly speaks to the growing integration of physicians into a larger care ecosystem and with other decision makers and influencers up and down the healthcare continuum. Within a complex ecosystem, sales, education, and partnership efforts may focus on the medical directors designing the protocols incorporated into electronic medical records, physician assistants who are responsible for the overall patient care management and follow-up, and the social workers helping patients with affordability issues. What’s more, the value drivers for medical directors, hematology oncologists and social workers vary, increasing the complexity of manufacturer sales and marketing efforts to target customers using the right leverage points and the right materials.
Understanding the components and function of the ecosystem is no easy business: As observed with HealthPartners, regions develop at different rates based on the interactions of payers, providers and—for lack of a better term—cultures. This requires nuance from manufacturers in segmentation and targeting. For example, to understand if a system is tightly managing treatment choice in oncology, it’s important to gain deep understanding, not just if order sets are used but whether these order sets simply reflect physician preferences or a larger consensus from the system on what treatment choice is truly delivering the most value. What’s more, the best materials and leverage points will vary by system. To enable field-based employees to effectively employ impactful materials and tactics, a robust and continuous communication loop between field-based employees and headquarters will be necessary. Certainly, the pharmaceutical industry will have to evolve to continue to fit in with the wider ecosystem.