Expanding Access to Care Through Academic-Community Cancer Care Collaboration

Harlan Levine, MD, president of health, innovation, and policy at City of Hope, highlights the benefits of the collaboration between community cancer centers and academic medical centers, including allowing for more access to patient care.  He spoke as a panelist for the panel titled “The Hunt for Value in Value-Based Cancer Care: How to Meet Stakeholders' Evolving Demands” at the 2023 Clinical Pathways Congress + Cancer Care Business Exchange.

Transcript

Dr Levine: Good morning. I am going to be giving a keynote speech at the start of session six, which is about the hunt for value in value-based care, and how to keep up with the evolving demands of our stakeholders. And I've recently been asked to participate in a panel that discusses the impact of health industry consolidation on cancer strategy and on cancer care.

What are you most excited about sharing with attendees from your panel?

Dr Levine: Well, there's three things I'd love if attendees could take away. The first one is that as we define value in value-based care, we have to incorporate the patient's perspective on value. We need to move beyond the focus on just affordability and think about what the patient prioritizes. What they care about is survival, the cancer care experience, how quickly they return to normalcy, and whether their care was coordinated and well-respected. I'll also add that speed is important to a cancer patient, and we need to remove those little speed bumps because to a cancer patient, wait is the four-letter word.

The second area is the need to modernize our definition of network adequacy. With all the innovation out there in terms of new genomics, data analytics, and targeted therapies, we need more access to academic medical centers for certain complex cancer conditions. And third and related is that we need to have a new integration between community oncology and academic medicine. They're both important pillars of the delivery system and they need to work more closely together to take seamless care of the cancer patient.

What are some of the most important data that were presented?

Dr Levine: Well, I focused on two areas in data. The first area was about the tremendous disparities in outcomes based on location and based on race. Take for example, African American men with prostate cancer die at twice the rate of their white counterparts with prostate cancer. Similarly, African American women die at a rate that's 39% higher than white women with breast cancer. So there's a huge difference, not only in the outcome of cancer, but there's also a difference in how they engage the health care system. For example, African Americans make up about 15% of cases of cancer in America, but they only make up about 4% to 6% of patients enrolled in clinical trials.

Dr Levine: The other data that I reported on was from published studies comparing the outcomes in Medicare Advantage compared to traditional Medicare. It turns out that for complex cancer surgery, this 30-day surgical mortality for patients enrolled in Medicare Advantage for liver and stomach surgery is 50% higher than those that are in traditional Medicare. Similarly, for pancreatic cancer surgery, the mortality rate is 100% higher, twice as likely to die in the first 30 days. Now the article didn't report on the causality, but we do know that Medicare Advantage plans to have fewer academic medical centers, fewer centers certified by the Commission on Cancer and fewer NCI centers. So I think these data elements really drive the point that we need to modernize our definition of network adequacy, and we need to create a system that better aligns community oncology with academic medicine.

What do you see as the biggest impact on cancer care?

Dr Levine: Well, I think the biggest impact in cancer care is undoubtedly the advances that are taking place in genomics and diagnostics and targeted therapies. But in the context of what we talked about today, there's two concepts I'd like people to think about. One is that cancer care is different, unlike other chronic conditions that are largely driven by patient behaviors. Stop smoking, drink less, exercise more. Cancer is really driven by did I get the right diagnosis and did I get optimal therapy? And we can't apply the tools that we use for other chronic conditions to cancer cases.

The second concept I'd like people to understand is that having health care coverage is not the same thing as having access. Too often we're seeing that many of the insurance products out there are going out there with narrow network products that have less access to academic medical centers, facilities that are certified by Commission on Cancer, NCI centers and high-volume hospitals. And in cancer, that makes a difference. With all the changes that are happening in modern treatment of cancer patients, we need more access to the academic centers than we've had in the past, not less.

What are some of the main benefits and challenges of what you have presented regarding value-based care?

Dr Levine: Well, we're living in an incredible time of progress in cancer care. So we should all be excited about the opportunities to save lives in the future. But we also have to recognize that this care is not equitably distributed to everyone. So we need to create a system where everyone has the access to all the progress that we're talking about. Now, I know affordability is important, but what we should be doing is taking all the advancements and the progress in genomics and diagnostics and therapeutics and data analytics and getting the waste out of the system, and then also getting the right care to the right patient as early as possible. So I think where the challenge is, is that we need to redesign or re-engineer our system to deepen the relationship between community oncologists and academic medicine so patients can get that care at the most appropriate site with the right treatment at the right time.