Ep 119 – Hope and Innovation in the Delivery of Value-Based Oncology Care, with Brad Hively and Dr. Dan Virnich

There is a need for hope and innovation in the delivery of value-based oncology care.  Cancer costs are on an alarming trajectory due to the aging and growth of our population. Oncology is currently the 3^rd most expensive specialty, but it is growing 3X faster than the top 3 specialties. Unless we find a way to replicate and scale value-based oncology care, it will be soon be the #1 most expensive specialty!  Value-based transformation in oncology is especially needed due to the high variability in cancer costs from state-to-state, as we see a 2-3X cost differential multiple between regional markets, with no correlation between cost and quality.  Eliminating cancer care disparities would prevent 34% of all deaths and save $230 billion in direct medical costs and $1 trillion in indirect costs to society. Furthermore, we are seeing financial toxicity in cancer care that results in 1 in 4 patients declaring bankruptcy within 2 years of diagnosis. And on top of that, 1 in 3 Medicare patients are refusing to fill lifesaving prescriptions due to high out-of-pocket costs. This financial toxicity in cancer care is disproportionately impacting minority and low income communities, leading to increased mortality, decreased quality of life, and lower survival rates.

To find hope and innovation amidst these grim statistics, look no further than The Oncology Institute of Hope and Innovation (TOI). Their highly specialized, value-based cancer care practice delivers cutting-edge, evidence-based cancer care to a population of approximately 1.6 million patients.  Oncology patients undergoing value-based care at TOI experience 40% fewer inpatient admissions, 75% fewer ER admissions, with patient satisfaction scores that are 14% higher than traditional oncology care.  Joining us in the Race to Value this week is Brad Hively (CEO) and Dr. Daniel Virnich (President) from TOI – the largest oncology practices in the US.  They discuss the importance of patient-centered high-quality, outcomes-based cancer care; emerging value-based oncology payment models; patient engagement and care coordination; clinical care pathways; physician compensation methodology; the importance of physician leadership in value transformation; and how to replicate growth at scale when delivery value-based oncology care.

Episode Bookmarks:

01:30 Introduction to the Oncology Institute of Hope and Innovation (TOI), Brad Hively, and Dr. Dan Virnich

03:00 TOI is the first specialty value-based care company to go public (November 2021) and has become one of the largest oncology practices in the US

04:00 The unsustainable financial trajectory of American healthcare with annual costs of cancer care ballooning to $209 billion due to aging and growth of US population

06:00 “Oncology is the 3^rd most expensive specialty in the senior population, but it is growing 3X faster than the top 3 specialties. It will soon be the #1 most expensive specialty.”

07:00 “From state-to-state, there can be a 2-3X multiple difference in oncology care costs, and there is no correlation between the cost and the quality.”

07:45 How do you replicate high value oncology markets across the country? (TOI is achieving 25% lower costs in oncology care.)

08:30 85%+ of oncology revenue comes from drugs (fee-for-service practices reimbursed at cost + 6% which creates a misalignment of financial incentives)

10:00 Medicare’s new value-based Enhancing Oncology Model (EOM) that is replacing the Oncology Care Model (OCM)

11:30 Brad explains why the voluntary Oncology Care Model has not generated as much savings as Medicare initially envisioned.

12:30 Brad discusses TOI’s participation outcomes in the OCM and how they are looking forward to EOM.

13:00 EOM will be slightly more limited (e.g. few cancer types included in the program, lower upfront care coordination payments).

14:00 The enhanced focus on health equity and patient navigation with the new EOM payment model.

15:00 An overview of the controversial mandatory Radiation Oncology (RO) Model

16:30 Dr. Dan provides context outlining the need for value-based radiation therapy

18:00 Suboptimal health literacy is an independent risk factor for poor health outcomes, including increased risk of hospitalization.

19:00 TOI has achieved 40% fewer inpatient admissions, 75% fewer ER admissions, with patient satisfaction scores that are 14% higher than traditional oncology care.

19:30 Cancer is unique in the amount of interdisciplinary care coordination that is required.

20:30 Coordinating cancer care between multiple specialists (e.g. surgeon, radiation oncologist, pain management specialist, PCP)

21:00 Additional support services are required in advanced cancer care (e.g. home health, palliative care, outpatient rehab) and how TOI’s high touch model

21:30 Dr. Dan explains the TOI high-value cancer care program that provides patient coaching, care coordination, and navigation assistance.

21:45 Benefits of care coordination (e.g. higher patient satisfaction, improved clinical outcomes, lower post-acute care utilization, and openness to advanced care planning discussions)

23:00 The importance of physician leadership and the opportunity to refocus attention on provider recognition, work-life balance to address physician burnout

24:00 Dr. Dan discusses the physician leadership model at TOI that elevates the clinical voice in making decisions for care delivery transformation

25:30 How TOI approaches the alignment of incentives with its physician compensation model

26:45 Do oncologists actually prefer a value-based compensation model?

27:30 Brad explains the importance of physician leadership in the governance of TOI.

28:30 Frontline practicing physicians are invited to meetings of the corporate Board of Directors to enhance communication, transparency, and collaboration.

29:00 Standardizing cancer care with clinical care pathways adopted from the National Comprehensive Care Network (NCCN)

30:00 Oncology clinical pathways align therapeutic decision-making with value-based care outcomes, e.g. the prescription of drugs to promote improved adherence.

31:30 Leveraging EHR optimization through order sets and advanced analytics to promote guideline-based therapy

33:00 The uses of telehealth in oncology and why the specialty is so well-suited for virtual care delivery

34:30 Brad discusses the tradeoffs between in-person and remote oncology care and how oncology is more heavily reliant on labs and pathology reports.

35:00 Dr. Dan on the impact that immunosuppression and second opinion seeking has in patient preference for telehealth consults.

37:30 Eliminating cancer care disparities would prevent 34% of all deaths and save $230 billion in direct medical costs and $1 trillion in indirect costs to society (report)

38:30 Dr. Dan provides an overview of TOI’s focus of health equity, focused on addressing high out-of-pocket costs for patients

40:00 Clinical trials often exclude non-English speaking patients which prevents underserved patients from accessing new innovative treatments

40:45 How TOI provides language proficiency and culturally competent care with its providers

41:30 The financial toxicity of cancer care (1 in 4 cancer patients go bankrupt within 2 years of diagnosis, 1 in 3 cancer patients go bankrupt within 5 years of diagnosis)

41:45 Lack of filled prescriptions due to cost (1 in 3 Medicare patients do not fill their prescriptions)

42:00 “Financial toxicity in cancer care disproportionately impacts minority and low income communities, leading to increased mortality, decreased quality of life, and lower survival rates.”

42:30 TOI now has 50 locations in 4 different states, serving 1.6 million lives under capitation.

43:30 “TOI represents a company where you can do well, while also doing good. Our vision is to be the leading value-based oncology group.”

44:45 Promoting replication at scale through practice pattern consistency