ATOPP Summit: Connecting at the Crossroads: When Provider and Patient Paths Converge
Benjamin Andrick, PharmD, BCOP, Assistant Director, Hematology Oncology Pharmacy, Geisinger, Danville, PA
Introduction:
The 3rd annual Advanced Topics in Oncology Pharmacy Practice (ATOPP) Summit took place July 13th to July 15th in New Orleans, Louisiana. This conference brought together oncology pharmacists, pharmacy leaders, oncologists, industry partners, and other healthcare professionals from across the United States to discuss challenges and opportunities. The conference focused on creating dialogue amongst attendees and discussing topics which are transforming the cancer care delivery landscape. The summit includes a variety of programming with continuing education sessions, small group workshops, and industry-engagement opportunities with the Peak Exchange Reverse Expo. A wide variety of networking events were held, providing valuable opportunities for attendees to connect with colleagues. Notable with the conference were opportunities to “Continue the Conversation” with facilitators about important issues such as: diversity, equity, and inclusion (DEI) within clinical trials, expanding access to cellular therapies, drug shortages, and workload metrics.
Keynote Address
Connecting at the Crossroads: When Provider and Patient Paths Converge
- Dr. Fumiko Chino: Memorial Sloan Kettering
- Danielle Gillepsie, RN
- Erin Buss, HOPA Patient Advisory Panelist
The panel discussed patients’ and providers’ perspectives and experiences with cancer care delivery.1 Dr. Chino shared her experience as a caregiver for her husband during his cancer treatment, noting the experiences were her catalyst to pursue a career as an oncologist. Ms. Gillepsie shared her experience as a glioblastoma survivor over the last 14 years. Ms. Buss previously had worked in the pharmaceutical industry for 15 years before her diagnosis with triple negative breast cancer in 2019 and subsequent treatment. The panelists shared powerful insights from interacting with the healthcare system to receive care for themselves or others. They contrasted the experience of cancer as a diagnosis versus proximity as a job, noting the importance of utilizing cyclical and pulse education as an ongoing conversation rather than a one-time occurrence to “check a box”. This approach addresses any information the patient or caregiver may have missed during one-time interactions. The panel discussed how caring for patients with experience in healthcare work can be particularly challenging, as it is easy to “assume” they know more than they admit. Patients may perceive “failure” for routine clinical events, like a toxicity dose reduction or a visit to the emergency room. Healthcare providers should discuss the why; tailoring education and listening to patient perspectives. A final comment from Ms. Buss[CL1] : even with all the evidence that science can provide, healthcare providers should not underestimate the impact their interactions and relationships with patients. These relationships create hope and “such hope is the most powerful drug.”
The panelists shared powerful insights from interacting with the healthcare system to receive care for themselves or others. They contrasted the experience of cancer as a diagnosis versus proximity as a job, noting the importance of utilizing cyclical and pulse education as an ongoing conversation rather than a one-time occurrence to “check a box.”
General Session
Hot Topics on The Hill (0.75 hr CPE)
- Dr. Lalan Wilfong: McKesson Specialty Health
- Nicolas Ferreyros: Community Oncology Alliance
- Jonathan Levitt, Esq. (Frier Levitt, LLC).
The panel discussed the impact of the Inflation Reduction Act (IRA) on cancer care.2 The IRA addresses medication costs by allowing CMS to negotiate drug prices with manufacturers for a fixed number of medications per year. The changes might have a negative impact on the research & development pipeline for manufacturers, but these are welcomed by employers who have been challenged by rising drug costs. The IRA is currently being challenged in the courts and likely full impacts will not be felt until 2028.
The panel discussed the evolution of the Center for Medicare and Medicaid Services (CMS) Oncology Care Model (OCM) to the Enhance Oncology Model (EOM).3,4,5 Notable differences between models include decreased number of patient populations to 7 high-risk cancer types, increased episode length to 12 months, and payment are now based on Monthly Enhanced Oncology Service (MEOS) and electronic patient-reported outcomes (ePROs). The new model requires practices to invest in infrastructure for appropriate documentation required for payment. The panel extensively discussed the importance of having quality documentation of ePROs.
Finally, the committee discussed pharmacy benefit managers’ impact on the rising cost of healthcare, with its lack of regulatory requirements, oversite, and standardization. Mr. Levitt highlighted defining medication adherence for payment as an example. Adherence can be difficult to measure due to stops/holds for toxicity, progression, etc. He emphasis understanding how your pharmacy’s metrics for adherence are being assessed as critical. There also was extensive discussion on Direct and Indirect Remuneration (DIR) Fee.
General Session
Expanding Access to Cellular Therapeutics: A Focused Discussion on Reimagining Access (1 hr CPE)
- Boro Dropulic, PhD, MBA: Caring Cross, Inc.
- Mylove Mortel, MSPH, RN, OCN
- Zahra Mahmoudjafari, PharmD, MBA, BCOP: University of Kansas Health System
- Gary Simmons, DO, MSHA: Virginia Oncology Associates
The presentation highlighted that cellular therapies are moving beyond traditional anti-neoplastic indications with the recent FDA approval of 6 cellular therapies for specialty conditions. 7 While the “sticker shock” of the cellular therapy can be daunting, it is important for ancillary costs for cellular therapy programs be included to the total cost. One reason for high costs of cellular therapy is manufacturing. Significant costs are incurred with coordination of logistics between clinical sites and central cellular therapy manufacturing facilities. Each commercially approved cellular product has its own individual manufacturing site. Thus, healthcare practices must have significant oversight to ensure chain of custody and coordination for cellular therapy products. One solution proposed to help lower costs and logistics is by addressing the manufacturing process. The panel shared that most costs are derived from the viral vector, and potentially the product could be manufactured at a lower cost. Dr. Dropulic spoke to the future opportunity for manufacturing at the point-of-care, which would minimize logistical direct and indirect cost with the current model.8 Finally, the panel discuss the importance of having a multidisciplinary team to review the process from start to finish for financial stewardship. The panel then discussed strategies to increase access to these therapies for both patients and healthcare sites.
Conclusion:
The 2023 ATOPP Summit provided a comprehensive and engaging program to address the most pressing issues and opportunities in oncology pharmacy practice. Additional content discussed at the Summit included DEI in clinical trials, novel therapies with HER2 low expression, therapeutic advances with hepatocellular carcinoma, and an incredibly interactive panel discussion of the role of CAR-T vs bispecific therapies for relapsed DLBCL. Importantly, the impact of patients’ perspectives and voices were deeply infused throughout the conference programing. This included challenges patients face in accessing and navigating the healthcare system for cancer care and ways our profession can mitigate such obstacles. Additional pharmacy-specific content included engaging discussion on pharmacy leadership practice management challenges with workload metrics and position justification, as well as implementation and stewardship for innovative therapies.
The summit provided attendees with knowledge, skills, and collaborations to provide optimal pharmacy and cancer care delivery services to our patients. The Summit was a motivating experience for attendees. While numerous obstacles and challenges exists within the current healthcare setting, the networking, collaboration, and discussion left attendees leaving the meeting with a sense of empowerment to return to their respective practices and make impactful changes for patients.
Recommended Reading/References:
1.Chino F, Gillespie D, Buss E. Connecting at the Crossroads: When Provider and Patient Paths Converge. 2023 Advanced Topics for Oncology Pharmacy Professionals Summit in New Orleans, LA; July 13, 2023
2.Inflation Reduction Act (IRA) Revised Program, 88 Fed. Reg. 42723. https://www.federalregister.gov/documents/2023/07/03/2023-14097/inflation-reduction-act-ira-revised-program-guidance.
3.Center for Medicare & Medicaid Services. Oncology Care Model. Oncology Care Model | CMS. Accessed December 10th, 2023.
4.Center for Medicare & Medicaid Services. Enhanced Oncology Care Model. Enhancing Oncology Model | CMS. Accessed December 10th, 2023.
5.Chong A, Witherspoon E, Honig B, Ela E, Cavanagh H, Strawbridge L. Reflections on the Oncology Care Model and Looking Ahead to the Enhancing Oncology Model. JCO Oncol Pract. 2022 Oct;18(10):685-690. doi: 10.1200/OP.22.00329. Epub 2022 Jul 18. PMID: 35849789.
6.Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, 87 Fed. Reg. 27704-27902, June 28th, 2022.
7.Mahmoudjafari Z, Simmons G, Dropulic B, Mortel M. Expanding Access to Cellular Therapeutics: A Focused Discussion on Reimagining Access. 2023 Advanced Topics for Oncology Pharmacy Professionals Summit in New Orleans, LA; July 14, 2023
8.Maschan M, Caimi PF, Reese-Koc J, et al. Multiple site place-of-care manufactured anti-CD19 CAR-T cells induce high remission rates in B-cell malignancy patients. Nat Commun. 2021;12(1):7200. Published 2021 Dec 10. doi:10.1038/s41467-021-27312-6
