The Next Step in Fighting Cancer: A Digital Management Platform?
It seems like everyone from billionaire Sean Parker to former Vice President Joe Biden is spending considerable amounts of time and money tackling today’s million-dollar moonshot cause: curing cancer. Their well-funded initiatives are helping to accelerate cancer research, make treatments more accessible to patients, and push for early detection and prevention methods — all critical elements of the cancer paradigm.
But one aspect of the fight against cancer that has not received nearly enough attention is the need for a comprehensive oncology benefit management platform. I envision a platform like this would coordinate care and information across patients, physicians, payers, and specialty pharma, ultimately improving cooperation and empowering patients to pursue the most clinically appropriate and cost-effective treatments.
This is becoming more relevant as many types of cancer can now be managed like other chronic conditions, such as diabetes or heart disease. In fact, we have seen five-year survival rates increase almost 40 percent between 1975 and 2010 as a result of earlier diagnoses, better treatments, and improved drug therapies.
This is terrific news until we look at the cost. Cancer accounted for an estimated $124.6 billion in medical expenditures in the U.S. in 2010. And in 2012, even while overall drug costs declined, oncology drug prices rose 22 percent. Going forward, cancer costs are expected to increase, in part because people with cancer are living longer, at a faster rate than overall medical expenditures. By 2020, national cancer costs will likely reach $158 billion, according to the National Cancer Institute.
What makes matters worse is that decisions about cancer care are sometimes made without real-time access to the latest clinical evidence, accurate treatment cost figures, and the consideration of effective alternatives. Patients are digging deeper into their own pockets under high-deductible health plans to fund the cost of cancer care, but they have little to no transparency about treatment decisions or their associated costs. Payers and employers are wary of getting involved in managing oncology benefits for fear of complicating an already messy system or appearing to impede access to care.
Another reason institutional players are shying away from oncology management is the increasing complexity of the cancer treatment landscape. Back in the early 2000s, oncologists had only a few first- and second-line treatment options at their disposal, which made managing care a whole lot easier. Today, patients can take up to four or five different treatment pathways, leading to an even wider variance in treatment approaches for patients who have the same type and stage of cancer. The cancer care landscape is becoming increasingly more complex and it’s ultimately the patients who suffer from being unable to effectively navigate it.
This is where a comprehensive oncology benefit management platform (OBM) comes in. The ideal comprehensive OBM platform should be one that coordinates care across the full cancer continuum to ensure that patients get the right diagnosis, right drugs, right dose, right treatment at the right time.
At McKesson, we are focused on moving our own U.S. Oncology Network in this direction.
An oncology benefit manager helps oversee the platform and coordinate drug management with the patient’s specialty pharmacy to improve medication adherence, track adverse reactions, and provide therapies in lower-cost settings like infusion clinics. Physicians would use the platform’s clinical decision support tools to help them land on the most effective treatment options for patients. Pharma companies would look to improve clinical trial access to bring life-saving therapies to patients sooner. And the whole system will look to improve the patient experience across every step of the process.
In order for us to build and scale this sort of platform, we still need to innovate across a number of areas. These include:
Drug discovery and clinical trials
New technologies are helping doctors determine the best forms of treatment, potential clinical trials, and personalized therapies for their patients. We are also seeing greater examples of artificial intelligence applied to drug discovery, clinical trial patient matching, and improved cancer diagnosis. The development of these types of technologies will be critical to the viability of a comprehensive OBM.
Oncology decision support
Oncology is one of the last major disease states to move toward treatment algorithms. And as cancer drug and treatment costs — and varieties — skyrocket, we need a way to help oncologists think through cost, quality, and outcomes for each patient and personalize treatment options for them using these clinical decision support tools. The next step here is not to only create treatment protocols and best standards of care, but also tie them to reimbursement and outcomes. Payers should look to get more involved in this sort of treatment standardization by creating reimbursement pathways with prior authorizations that follow screening and treatment protocols. The best examples of these solutions are those that integrate electronic medical records in a way that makes the data in those records actionable for physicians caring for patients. This sort of data integration will be critical in helping these solutions take off.
Precision medicine and diagnostics
In the future, we will likely see payers and providers being more proactive about conducting genetic testing to detect cancers at an earlier stage. More personalized care plans will help physicians monitor and detect cancer in their patients earlier than ever before. With advances in liquid biopsies, we can also determine much earlier the first traces of tumors in the blood so oncologists can take action sooner with non-invasive treatment options.
Cancer care coordination and patient engagement
Patients are paying more money out of pocket with growing high-deductible plans and more confusion around all the various treatment options. To alleviate some of these pain points, payers and providers should focus on ways to improve the overall experience of care and take into account patient preferences. We are seeing progress in this area with the emergence of more patient-friendly and convenient infusion clinic centers, to 24/7 access to nurses to report side effects of treatments.
With the cancer care ecosystem becoming more expensive, complicated, and bloated, we need to find a solution that promises to cut through the bureaucratic knots and empower patients to take control over their treatments. An oncology benefit management system has the potential to bring patients, doctors, payers, and pharmaceutical companies on the same page, using the same data and making decisions transparently.
Creative Art Direction by Redindhi Studio. Illustration by Rune Fisker.
