Navigating Multidisciplinary Care: Insights on Oncology Practice Integration and Pharmaceutical Partnerships

John Hennessy, Principal at Valuate Health Consultancy, highlights the importance of multidisciplinary collaboration in oncology care to improve patient outcomes.

Transcript:

John Hennessy: Hi, I am John Hennessy. I'm a principal with Valuate Health Consultancy and I'm here at the Cancer Care Business Exchange. I come every year because, as I described to someone yesterday, this is one of the meetings where you really do pay attention. It's very difficult to step outside of the room because you know you're going to miss something if you're not in for all of the presentations.

How does multidisciplinary care within collaborative practices improve patient outcomes?

John Hennessy: Oncology is a group experience. It is, by its very nature, multidisciplinary. It starts out with primary care physicians, typically, or sometimes radiologists who recognize that there is a problem that needs to be addressed. That then goes to collaboration with other physicians. We think of medical oncologists, but surgeons, interventional radiologists, pathologists, and radiation oncologists all have a role in helping patients through this cancer care journey. The more they work together early in the patient's care and, more often than ever, late in the patient's care, we find that patients are well supported, families are well supported, and the journey is as good as it can be.

What best practices have emerged from successful integrations within multispecialty groups?

John Hennessy: I think there have been a lot of best practices. The tumor board was one of the early things that we adopted in oncology to get people to work together. But what we've seen are things in multispecialty groups like curbside consultations where physicians can meet each other in the hallway and talk about difficult cases often while the patient is still in the office and help make better decisions based on information like that. We've seen how having integrated radiologists, particularly radiologists who focus exclusively on hematology/oncology care, can provide not only better answers, but more specific answers that are meeting the needs of both the oncologist and the patient. Finally, at end-of-life care, we find that the transition between treatment and supportive care is often best managed when both the medical oncologists and the palliative care physicians are collaborating. This is a journey, and it's a long journey for patients, but the more there are hand-holding events and the less there are gaps in that journey, the better off the patients are, and quite frankly, the better off the healthcare system is.

What are the main challenges organizations face when they try to integrate medical oncologists into urology groups, for example, or urologists into oncology practices?

John Hennessy: The good news is everybody is a doctor. But there are “oil and water” circumstances involved. When you look at integrating medical oncologists into the urology practice, you're taking a surgical specialty and bringing someone in a medical specialty in, and the way the compensation models work, the way that they generate their value, is a little bit different. The integration of those 2 practice patterns into an established compensation model is really challenging. Any time you are bringing 1 of something into a group of a lot of other things, it reminds you of Sesame Street when they used to ask, “Which thing doesn't belong with the other?” It's just much tougher work. I think for the physician who's the only 1 who is different, integrating into that practice and being truly part of the group of the practice can be more challenging than we think.

In many cases, there are folks who are the early adopters, who learn these lessons, and maybe the lessons that come out of it are, you can't just go in by dipping your toe in the water; you have to make a more significant integration. Rather than just bringing 1 medical oncologist in, bring a group of medical oncologists in, or, as we've seen in other circumstances, medical oncology practices bringing groups of urologists in so that they can maintain the uniqueness of that structure or that type of practice within the larger group practice that they are belonging.

Can you provide more detail on which solutions are effective in these practices?

John Hennessy: There are many cases where you have seen medical oncology practices bring radiation oncology and surgical oncology, and we've seen palliative care doctors join these practices—largely successful, but we've had failures as well. Some of that is structural; some of that is about the culture of the group. All of those things have to be aligned, and you have to figure out how this is going to work beyond just the recruitment process and buying the equipment. How is this person going to be able to maintain the autonomy that they enjoy in private practice while joining a larger group of physicians? Where we've seen struggles have been just trying it a little bit. I think you either have to be all in or all out, and for those who are just trying it to see how it works out, too often it just doesn't stick. It's not enough of a reason to fight for it. I don’t know if you remember the old commercials from Camel cigarettes, “I'd rather fight than switch.” Too often it's not a fight and they just switch. So I think it's really about commitment. It's about culture and making sure the practice is ready to be bigger than it was, more diverse than it was, and more inclusive than it was.

How can pharmaceutical companies position themselves as partners when trying to overcome integration challenges?

John Hennessy: The pharmaceutical companies can be partners in understanding the challenges that these groups have. Particularly, when you think about the urology practice adding a medical oncologist, we've seen limited successes and we've seen a lot of trial and error there. The idea that both the urologist and the medical oncologist can be part of a team that's managing the patient at the same time and it's not one or the other is really important. You want to understand that the urologist will continue to be a manager of bladder cancer patients and prostate cancer patients, alongside that medical oncologist. A lot of times you just have to be a good listener, experience the practice dynamics, and see how those practitioners work together, how they share patients, how they transfer patients to make sure that when you are reacting to them, you're reacting to them in the way they behave rather than the way you wish they would behave. A practice that I'm very familiar with is when there are different urologists who refer patients to the medical oncologist at different times. Sometimes they refer to them for systemic therapy; sometimes they refer to them for supportive care. Understanding those behaviors and making sure, again, that we're bringing what we offer to the practice and not making the practice change to the way we think the world ought to work are things that are going to be really important in supporting those relationships and making sure they're successful.

How can pharmaceutical companies navigate stakeholder engagement and education strategies to support market access in these complex organizational structures?

John Hennessy: We spend a lot of time in our work with pharmaceutical companies talking about the patient journey. I think it's worthwhile to put the shoes on of the practice and understand the practice journey—not just how the patient works through their journey of primary care surgeon, medical oncologist, radiation oncologists, but how the practice manages that. We like to think about things like mapping that out and understanding that it's not just one-size-fits-all, that each practice is a little bit different. Quite frankly, each community is a little bit different. Sometimes we find that in a practice setting where there are small urology practices and a big academic center, there's not only just what happens within the practice but also between those 2 entities. My thought is that you would want to make sure it's not just the patient journey you're thinking about, but how the practitioners are making this journey. I would include in that the pharmacists who work in these practices, the advanced practice practitioners, and the financial counselors, all those folks have a role in that journey. The more you understand that, the more you can understand the challenges those practices face.