QCCA Committee Highlights Expanding Innovation at Independent Community Oncology

Value management, theranostics, access to clinical trials and a mobile pharmacy are major innovations integrated into independent community oncology highlighted at the Quality Cancer Care Alliance Summer 2022 National Leadership Summit .

Members of Independent Oncology Practices Gathered to Discuss Value Management, Theranostics, Access to Clinical Trials and Pharmacy Innovations at Quality’s National Summer 2022 Leadership Summit Cancer Care Alliance (QCCA), held August 10-12, 2022, at the Bell Harbor International Conference Center in Seattle, Washington.

Focused on “Harnessing Innovation in Independent Community Oncology,” the summit included panels on topics such as the shift from the oncology care model to the oncology improvement model and CAR-T cell therapy.

To kick off the meeting, Sibel Blau, MD, President and CEO of QCCA, led a panel on integrating innovation into independent community oncology. Join Blau to share how their practices are innovating on the ground:

  • Alti Rahman, Practice Administrator at Oncology Consultants
  • Beth Page, COO, Director of Compliance at Cancer Specialists of North Florida
  • Frank Senecal, MD, director of oncology at Franciscan Healthcare System, Northwest Medical Specialties
  • Justin Floyd, DO, president of Cancer Care Specialists of Illinois

Value management

According to Rahman, value and impact are the 2 main drivers of innovation.

“If you don’t like it, you won’t change it,” he said, noting that change must start at the top with an alignment of values ​​between an organization’s management and board, because value management is necessary at all levels and in all aspects of an organization.

Additionally, the work structure, whether or not there is an established team focused on the problem, and the resources invested to create that innovation all determine the value placed on the innovation.

“It’s not something you’re looking to generate a return on investment [return on investment] out, Rahman pointed out. “It’s something you invest in to create a stronger foundation and roots in what we do in community practice.”

His second point was, “If you can’t measure it, you can’t change it.

Based on this, it is important for the organization to set a clear goal within its boundaries, as well as to understand the scale of the problem to be solved and how the impact of innovation is measured.

Rahman explained that the provider’s job begins in the middle of the patient’s journey after receiving a diagnosis. However, the provider must not only focus on how to get things done effectively operationally, but also think about the patient’s journey so far and how their life is affected after treatment.

Rahman identified pre-clearance as an area needing review; he said it added unnecessary time to the patient treatment process. To solve this problem, oncology consultants looked at how time was spent and invested in automation, reducing the turnaround time from 20 minutes to 11.8 minutes.

Additionally, after filtering out parts of the process deemed not to add value, including redundancies and repetitions, the overall authorization process went from 2-3 days to 1 day from when the doctor ordered the therapy to when the prior authorization was approved. by the payer.

“When we look at our organization, we need to continuously assess what we’re doing and then look at the capacity for change and improvement throughout a culture of innovation,” Rahman concluded.

Theranostics

Page explained theranostics, which are precision therapies that combine therapeutics, diagnostics, and nanoscience. This type of treatment uses one radioactive drug to identify and diagnose a malignancy, and another to deliver therapy for the malignancy and any metastatic tumors.

In comparison, traditional radiation therapy targets only one site of disease, making radiation therapy less effective for patients with metastatic tumors. The radiation can also damage healthy tissue surrounding the malignant tumor.

Theranostics available from Cancer Specialists of North Florida include lutetium Lu 177 vipivotide tetraxetan (Pluvicto), lutetium Lu 177 dotatate (Lutathera), and radium Ra 223 dichloride (Xofigo). Data presented at the QCCA Summit shows that Lutathera and Xofigo generate over $8,000 and $2,200 in average profits per injection, respectively.

Page emphasized the importance of properly operationalizing this therapy, pointing out that practices that fail to put the right system in place risk losing out.

To avoid this loss while minimizing waste and improving the patient experience, Page explained that cancer specialists in North Florida have a team that meets on the same day each week. This team includes 1 member who takes care of the planning, 1 part-time nurse who stays in the room with the patient for 6 hours to avoid pulling a nurse from the chemotherapy floor of the clinic and 1 imaging technician who is with the patient for about 30 minutes to administer the doses.

This team also moves between sites on different days of the week, but always consists of the same members on the same schedule.

Blau added that standard operating procedures are being developed to help firms build these teams.

According to Page, the global theranostics market is expected to grow 9.6% per year through 2028, reaching a value of over $123 billion. The main factors driving this growth are the increasing prevalence of cancer and other chronic diseases, as well as increasing investments in biological research. At the same time, this trajectory could be hampered by challenges surrounding the regulatory landscape and the lack of reimbursement policies.

Clinical trials for this therapy are ongoing, with phase 3 trials underway at Telix Pharmaceuticals for TLX591, which is expected to reach commercialization within the next 12 months. Additionally, a Phase 4 trial in Zionexa is being initiated for Cerianna.

CAR T-Cell Therapy, South Sound CARE

Most CAR T-cell therapy programs are available in hospital settings, especially in metropolitan areas. In the Northwestern United States, according to Senecal, this means that many patients eligible for therapy who are referred to a limited number of centers have to wait longer to access it.

“The result of that is that there’s often a 2-month, 3-month waiting list to get patients into therapy,” Senecal explained. “Furthermore, the rules and regulations of Fred Hutch [mean] patients must stay in Seattle after receiving their treatment, so patients commit to staying for quite an extended period of time.

Senecal is also the founder of the South Sound CARE Foundation (SSCF), which aims to increase access to clinical trials and cancer research closer to patients in the South Sound area, and to provide residents with options cancer treatment such as CAR T cell therapy that are otherwise unavailable in their area.

Topics of ongoing trials under the SSCF include blood cancers, breast cancer, genitourinary cancer and quality of life.

SSCF also has a number of compassionate use trials for physicians and providers, designed for patients who no longer respond to standard treatment.

“These are individual ‘trials’ in which the FDA and pharmaceutical companies work together to provide access to drugs that are effective for specific tumor traits but not available through other sources,” the foundation’s website explained. “The South Sound CARE team coordinates the process for our patients, facilitates applications, and locates potential compassionate use programs within the pharmaceutical industry willing to partner to provide medicines for free to patients.”

mobile pharmacy

According to Floyd, delivering specialty drugs to patients presents several challenges, including high costs, varying drug half-lives, and access to specialized infusion staff. Additionally, many patients have limited access to cancer care, particularly if they are older, live in a rural area, or live in a smaller, vulnerable, or generally underserved population or geographic area.

In addition to this, patients are sometimes unable to keep their appointments due to travel, poor health, and various other reasons.

Floyd also noted that while Cancer Care Specialists of Illinois (CCSI) has been operating successfully for 30 years, he realizes the care design model is geographically challenging.

To overcome these hurdles, CCSI created a “first-of-its-kind” mobile pharmacy, a pharmaceutical dispensing vehicle that is not a licensed pharmacy, but helps deliver cancer care to patients by providing on-site preparation of chemotherapy drugs.

Drug wastage issues have also become a major problem in pharmaceuticals, both environmentally and financially. Chemotherapy drugs can be very expensive, and if they are transported to a center and no longer needed, they must be disposed of, contributing to both wasted resources and healthcare costs. high health.

With Mobile Pharmacy, chemotherapy drugs are not mixed until patients are seen in the hospital and an exact prescription is made, saving valuable medical resources while reducing the environmental footprint of cancer care.

It also led to financial savings, with Floyd noting waste savings of $664,248 in 2020, $804,833 in 2021 and $278,722 so far in 2022.

Finally, Floyd suggested that compounding drugs on-site can improve patient access to clinical trials because they are no longer required to travel to a central hub for investigational drugs.

About Jonathan J. Kramer

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