Physicians Must Become Advocates to Play a Role in Community Oncology’s Future

Jonathan Coggins, MHA

The past decade has been tumultuous for community oncology, and practices have had to adjust to many transformative changes. The volume of this transformation in oncology, and more specifically community oncology, is staggering when the effects of several factors are quantified. These include the rising cost of care, disease prevalence, the increasing complexity of cancer care, competitive labor markets, COVID-19, hospital acquisitions of practices, evolving standards of care, consumerism in health care, evolving technology, payer-provider pharmacy benefit manager alliances, reimbursement reform, and the 340B program. Indeed, the degree of transformation that the oncology care industry is facing is readily apparent.

Lisa Langenderfer

Undoubtedly, more changes are to come. However, at the center of most of the disruption is the focus on bending the cost-of-care curve to create a greater degree of financial sustainability in oncology (Figure 1). Most payers, providers, and patients see the shift to value-based care (VBC) as a progressive step to helping to mitigate the disease burden. The pace of this evolution and the degree of fragmentation in this reimbursement modality are increasing. Although some community oncologists may think they can do little to abate the reimbursement reform forces that are affecting their practices, there are actions they can, and should, take to influence the success of their VBC journey that may not be part of the fundamentals of their current practice.

Figure 1. National Cost of Cancer Care (2010-2020)

Getting Involved Is No Longer Optional

Community oncologists can have a greater role in shaping
a health care landscape that will enable them to thrive, but they must first become much more proactive in developing and executing strategies that will empower them to overcome ongoing challenges.

Aggressively Advocating for the Practice

Oncologists are used to advocating for their patients but not for their own practices. They need to step forward and vigorously become the voice of the practice as well as a champion for community oncology.

A good place to start is to establish strong relationships with governmental representatives at all levels—local, state, and federal. These representatives must understand how community cancer centers operate and the many benefits they provide to patients, the community, and the entire health care system, as well as the challenges they face. Practices should make a dedicated effort to create outreach programs with their elected officials, including Capitol visits and, even more impactful, visits by representatives to their clinics. Lawmakers usually embrace these invitations whenever possible, as they present an opportunity to show support for the cancer community and the availability of high-quality cancer care in their respective districts. Practices that partner with The US Oncology Network benefit from its legislative and policy expertise and experience in direct engagement with key decision makers.

Another critical part of advocacy involves following bills as they make their way through state and federal legislatures. A number of states have legislation in the works supporting community oncology. Practices affected by this legislation need to get involved, becoming a voice and a champion for these bills with their legislators and advocacy groups. Conversely, it is just as important to weigh in on legislation that could unintentionally harm the practice of community cancer care. Although it may be difficult for busy practices to follow legislation that could affect them, The US Oncology Network Government Relations and Public Policy Department maintains an informative website, legislink.com, that tracks both state and federal legislation related
to community oncology, making it easy for practices to become informed and advocate for important issues. Further, by fostering a committed cohort of physician and administrative champions and dedicating focused time at the practice’s strategic planning forums and regular board meetings, practices can consistently create opportunities to influence reimbursement and cancer care legislation.

Building Innovation Into the Practice DNA

Given the rapid changes occurring in health care, community oncology practices that are not keeping pace are moving backward. There has been an ongoing march toward value-based oncology care for the past decade, and community practices need to be prepared for the continued evolution and complexity of this reimbursement model. Those who have not made the necessary adjustments to their practices and invested in crucial VBC infrastructure could lack the overall technical sophistication and proficiencies needed to succeed in the new value-based delivery framework.

VBC is here to stay, and oncology practices can expect the oncology space to move to an even higher degree of VBC soon. Practices that participated in the Oncology Care Model are likely better positioned to succeed vs their counterparts, as over the past few years they
have invested in the technologies, solutions, and resources necessary to meet the complex requirements that are continuing through the Enhancing Oncology Model and many commercial payer models that tend to share design principles with Center for Medicare & Medicaid Innovation and Centers for Medicare & Medicaid Services programs. These practices embraced innovation and technologies, putting them at the very heart of their operations to empower new and better ways to care for patients.

Practices that have not yet participated in VBC must expeditiously innovate everything from the practice structure and workflows to data capture, analytics, and reporting, all the way through revenue cycle management—a monumental task that must be done in short order given that mandatory value-based models are likely right around the corner. Physicians who champion VBC and lead by example are critical to achieving practice transformation.

However, the complexity of oncology-centered technology is no longer around the infrastructure needed to support VBC alone. Instead, both governmental and commercial payers are integrating new and even more complex requirements into VBC programs, including patient experience and health-related social needs. These new aspects of VBC will require technology enablement and, more importantly, a holistic practice and patient-centered technology strategy that fosters flexibility for future requirements and reforms. This technology innovation is especially critical, as the demographic mix using technology includes more than just younger generations. Recent research indicates older patients are actively using technology in new and innovative ways, including engaging with health care providers (Figure 2).

Figure 2. Adult Smartphone Ownership and Use in the United States by Generation

Forming Alliances With Professional Trade Associations

Community oncology has historically faced challenges in broadly adopting a strength-through-scale concept. In addition to engaging alongside other Network practices, practices and physicians should take advantage of the many leading community oncology advocacy groups, such as the Community Oncology Alliance,
the National Community Oncology Dispensing Association, the Institute for Value-Based Medicine^®, and the Quality Cancer Care Alliance.

These organizations are strong advocates for cancer care in the community setting, continually working at the forefront to stop legislation and payer mandates that can adversely affect community oncology. However, they cannot do it alone. Community oncologists need to become active in these industry groups and work jointly with their peers, as participation will be key in developing strong advocacy for community-based providers, both in the immediate future and for the long term as complexities and challenges continue to emerge.

The Time for Action Was Yesterday

Community oncologists must realize their silence—inaction can be detrimental. Given the litany of external forces and influences exerted on community oncology, every community oncologist must step forward and advocate for themselves, their patients, and their practice if they want to thrive in the future.

Jonathan Coggins, MHA, is vice president of provider strategy and operations for the US Oncology Network and McKesson Provider Solutions.

Lisa Langenderfer is senior director of federal government relations for the US Oncology Network and McKesson Provider Solutions.