Building the Oncology System of the Future: Transforming Patient Care Through Data Transparency and Analytics

08 October 2014 Health Care Law Today Blog

Virtually everyone agrees that the time is now to seriously reexamine our fragmented, expensive healthcare system and to innovate sustainable approaches to curing its ills. At the center of this activity is the patient, as the ultimate consumer of healthcare services. Until recently, patients largely have been shielded from healthcare costs by health insurance and governmental payment programs with low copays/deductibles or first dollar indemnity coverage. Patients have also been relatively unaware of quality differentials because of the lack of standard reporting on meaningful quality measures.

Today, as a result of governmental and private market “transparency” initiatives, an increasing amount of quality and cost information is becoming available to the public; and patients have greater incentives to make cost effective choices about their preferred site and providers of oncology care. One of the new dynamics driving oncology consumerism is new health insurance product designs that involve higher patient copays for more expensive care options and limited, tiered and exclusive provider networks. Site of service differentials and provider-based copays are also impacting patient choices. Also driving oncology consumerism is increased activism by employer self-funded plans that are offering healthy lifestyle incentives and, in some cases, disincentives for unhealthy behaviors. Oncology consumerism is further emboldened by disruptive information and medical technologies that give patients enhanced self-care capability, with access to a trove of health information. These include electronic health monitoring and internet or home-based support services, including specialty pharmaceuticals.

While the “science” of quality and value measurement is in its infancy, some innovative oncology organizations are collecting and analyzing reams of potentially actionable data. These data analytics are an engine of evidence-based change for the benefit of consumers—but in directions that are not always intuitively obvious or welcomed by the status quo.

During this time of disruptive change, cancer care providers are understandably concerned about reimbursement reductions; about being excluded from payer contracting networks; about patient incentives to use less expensive providers; about losing referral sources as primary care physicians and other specialists align with specific networks; about the pressure to give up practice autonomy and become employees of hospitals or large multi-specialty groups; about the impact of new value-based, alternative payment arrangements (like shared savings, bundled payment, episode of care, and capitation arrangements); about the impact of ACOs, medical homes and other clinically integrated care organizations; and about the trend toward industry consolidation that threatens their professional autonomy.

In this new consumerist and cost conscious health care environment, there are critical questions to be answered about what innovative strategies and solutions are available to community oncology providers to build the successful oncology system of the future.

At the 2014 Cancer Center Business Summit (November 6-7 at the Fairmont Hotel in Chicago), you will have the opportunity to learn from industry leaders and community oncology stakeholders about the changes occurring in the cancer care marketplace and how oncology organizations are responding to those changes. Visit the Cancer Center Business Summit website to get more information and to register.

This blog is made available by Foley & Lardner LLP (“Foley” or “the Firm”) for informational purposes only. It is not meant to convey the Firm’s legal position on behalf of any client, nor is it intended to convey specific legal advice. Any opinions expressed in this article do not necessarily reflect the views of Foley & Lardner LLP, its partners, or its clients. Accordingly, do not act upon this information without seeking counsel from a licensed attorney. This blog is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Communicating with Foley through this website by email, blog post, or otherwise, does not create an attorney-client relationship for any legal matter. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary. The information on this blog is published “AS IS” and is not guaranteed to be complete, accurate, and or up-to-date. Foley makes no representations or warranties of any kind, express or implied, as to the operation or content of the site. Foley expressly disclaims all other guarantees, warranties, conditions and representations of any kind, either express or implied, whether arising under any statute, law, commercial use or otherwise, including implied warranties of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Foley or any of its partners, officers, employees, agents or affiliates be liable, directly or indirectly, under any theory of law (contract, tort, negligence or otherwise), to you or anyone else, for any claims, losses or damages, direct, indirect special, incidental, punitive or consequential, resulting from or occasioned by the creation, use of or reliance on this site (including information and other content) or any third party websites or the information, resources or material accessed through any such websites. In some jurisdictions, the contents of this blog may be considered Attorney Advertising. If applicable, please note that prior results do not guarantee a similar outcome. Photographs are for dramatization purposes only and may include models. Likenesses do not necessarily imply current client, partnership or employee status.

Related Services