Medical care in the United States continues to move away from a fee-for-service model, increasingly working towards the promotion of value-based care. The Oncology Care Model (OCM), developed by the Centers for Medicare and Medicaid Services, serves as one of the major payment and delivery tools for practicing oncologists around the country.1 A significant amount of research has centered around how to best use the OCM to foreground the best possible care at the best possible cost.
Ray D Page, DO, PhD, FACOI, medical oncologist and hematologist at The Center for Cancer and Blood Disorders (Weatherford, TX), and colleagues investigated the impact on quality measures and care planning of implementing lung cancer testing as part of routine practice. In a study published in Managed Care,2 Dr Page and colleagues found that using the VeriStrat test accurately predicted therapeutic and treatment outcomes for patients with lung cancer, while helping patients and providers avoid expensive and ineffective treatments. “By providing independent prognostic information, the VeriStrat test is a validated, commercially available tool that physicians can use to improve cancer care planning and composite performance scores associated with quality payment models,” Dr Page and colleagues wrote.
Journal of Clinical Pathways recently spoke with Dr Page about the continued validation of the VeriStrat test, the role of testing within clinical pathways, and their effect on the OCM.
Can you talk about the OCM Quality Care Model discussed in your paper?
The OCM was created by Medicare in order to improve the quality of care, while also saving on costs. The quality measures put forth in this program are many; however, when treating patients with lung cancer, prognosis and expected response to therapy are always key considerations to prolong patient survival and maintain quality of life. For that reason, there are measures that we evaluate in this publication.
Can you summarize the objectives of your study and what you found, insofar as how prognostic tools such as VeriStrat can aid in achieving optimal quality measures.
It’s important to share knowledge around quality of care and available innovative tools with other physicians who treat patients with lung cancer. Therefore, the main objective was to offer insight to physicians as to how tools like VeriStrat can help them meet their OCM measures while also improve outcomes and the patient experience. Additionally, there are some prognostic tools that have been used a long time that help establish prognosis, and those can be used to help give us an understanding of a patient’s state prior to administering therapy. It also needs to be determined whether these tools are sufficient in facilitating these decisions, and if there is a need for more objective measures, such as a VeriStrat test, to do so.
Guidelines that support physician/patient communication about prognosis and planning for cancer treatment are well-documented in your study. In your experience, are physicians adhering to these guidelines?
This is a work in evolution, and general physicians have plenty of room for improvement in discussions of prognosis and end-of-life planning. There are challenges related to physician time, the physician/patient relationship, and what the patient’s life goals are. It requires ongoing education, education, and even more education—on both sides—to achieve the best decisions and the most meaningful outcomes for the patient.
In your institution, is prognostic testing included in your clinical pathways? How do physicians feel about using it? Are there any challenges presented by this type of testing?
There’s a variety of tests that have a prognostic implication. Such tests include Oncotype DX and MammaPrint for breast cancer, mismatch repair genes, epidermal growth factor receptor (EGFR) testing, and VeriStrat. Many of these tests are included in our pathways, and they are strongly recommended to help guide treatment decisions.
Others are suggested as an option to think about in the course of patient management. Our physicians use the Via Oncology pathways to make clinical decisions on every single patient, and they are all very comfortable working within a pathway system. But there are always challenges when you ask a physician to change their practice habits—whether it be treatment decisions, supportive care, drug choices, or the use of diagnostic and prognostic tests. There is always a challenge of getting physicians engaged with new technology and treatment tools.
Are you aware of any other studies regarding the cost-effectiveness of VeriStrat? Are there data not included in the study that suggest VeriStrat helps patients avoid costly and ineffective overtreatment?
There have been multiple peer-reviewed publications on the impact of VeriStrat on physician decision-making, and the subsequent cost savings that are involved in those decisions. One study that was conducted by Hornberger and colleagues3 in 2015 looked at the ability for VeriStrat to select patients who would specifically not benefit from EGFR tyrosine kinase inhibitor therapy. They proved that VeriStrat could offer a cost savings of roughly $135 per patient, and that also includes the cost of VeriStrat testing at that time.
Recently, Akerley and colleagues4 determined that the prognostic effect of VeriStrat had an even more significant effect on physician decision-making, specifically in respect to supportive care and discussions around hospice care. Prior to using VeriStrat, physicians recommended supportive care for roughly 1% of their patients. Following receipt of VeriStrat test results, 25% of patients—roughly one in four—who tested “VeriStrat poor” were recommended for best supportive care. By using the prognostic value of the test, VeriStrat offers a cost savings of more than $10,000 per patient for those who test VeriStrat poor, and an offset in pharmacy spending of around $6300 per patient regardless of their VeriStrat test results. It’s also important to note that the costs I am mentioning include the cost of the VeriStrat test, adverse events, and surveillance.
Is there anything else you want to say on this topic?
As we make a direction toward taking physicians from fee-for-service toward quality measures and overall patient outcomes, this paper just shows the opportunity that you can use a good biomarker test like VeriStrat for solid physician/patient shared decision-making purposes. You can use it to determine whether it is the best choice to continue on with further therapy, or maybe start discussing palliative care and end-of-life decisions. I think this study does a good job of putting the role of VeriStrat in those quality measures for lung cancer.
References
1. Oncology Care Model. Centers for Medicare and Medicaid Services website. https://innovation.cms.gov/initiatives/oncology-care/. Accessed October 30, 2017.
2. Page RD, Argento AC, Nash DB, Skoufalos A, Schaefer ES. The role of proteomic testing in improving prognosis and care planning quality measures for lung cancer. Manag Care. 2017;26(9):37-47.
3. Hornberger J, Hirsch FR, Li Q, Page RD. Outcome and economic implications of proteomic test-guided second- or third-line treatment for advanced non-small cell lung cancer: extended analysis of the PROSE trial. Lung Cancer. 2015;88(2):223-230.
4. Akerley WL, Arnaud AN, Reddy B, Page RD. Impact of a multivariate serum-based proteomic test on physician treatment recommendations for advanced non-small-cell lung cancer. Curr Med Res Opin. 2017;33(6):1091-1097.
