Download The New Oncology Practice

Proving Value in
Oncology: The Visible
and Invisible Issues
Dawn Holcombe, FACMPE, MBA, ACHE
President, DGH Consulting
Executive Director, Connecticut Oncology
Association
Today’s Agenda

Understanding Oncology and Specialty
Pharmacy

Overview of CMS and Private Initiatives

Practices: Proving Quality Care

Implications and Future Issues
5/23/2017
Part I - Evolution of Oncology
The future lies in the past:

Need to know how we got here

To determine how to move forward

In 1971, President Nixon signed into effect the National
Cancer Act of 1971, declaring war on cancer and the
devastation it wreaked on American life. From this
initiative, millions of dollars flooded universities and
research centers.

5/23/2017
The Evolution of Oncology

new specialty, born in the early 1970s.
 “Love Story” Brian’s Song”

Dramatized trauma of terminally ill patients leaving
homes and families to seek treatment, but more often
concluding their lives in hospital beds, after having
struggled with their illness and the side effects of
cancer treatments

Inpatient, lengthy stays
 Toxic, single agent drugs
 Debilitating side effects
5/23/2017
DGH Consulting
A new breed of “primary specialist”
 1973,
medical oncology programs were
graduating a new breed of physicians
specially trained in multidisciplinary
oncology practice and clinical research.
While surgeons had dominated cancer
care during the 1950s and 1960s, medical
oncologists soon became the primary
clinicians for patients with malignancies,
coordinating multi-disciplinary care
5/23/2017
Supportive Care Evolution
-Side Effect Management
-Outlook on Life
-Allowed toxic drugs to be delivered in
outpatient settings while avoiding
complications
5/23/2017
Infrastructure Grew
 More
Similar to Infusion Suites than
Physician offices
 Emergency Care Watch Constant
 Adverse Reaction Management
 Oncology Certified Nurses
 OSHA – Management of bio and
hazardous waste
5/23/2017
Inherent Flaws in Payment System
 RVU
Basis
 Created
 Profile
5/23/2017
in Early 1990s on older data
of Oncology vastly different
AWP and Professional Payments
Aggregated – an Efficient Care
Delivery Stream
 Mislabeled
Buckets, Same Net Amount of
Money
 Years of MisLabeling lead to confusion
and Frustration on all Sides
 Cancer Care Continued to Evolve, despite
Stagnant Payment System
5/23/2017
Specialty Pharmacy Management
and Payer Perspective
 New
Opportunity for successes in other
specialties
 Big dollars, big target
 Slow and sporadic entry
 Mixed understanding of oncology issues
 Does
Spec. Pharmacy add value
or costs in oncology?
Specialty Pharmacy
 Started
in 1970s
 High cost specialized drugs (hemophilia)
 Unreliable delivery/availability
 Addition of PBM tools
 Oncology as a target before understanding
the specialty
 SPs. PBM lines blurring
What is Specialty Pharmacy?
 MD
call and order treatment
 Reviewed and approved by SP
 Drug shipped to MD or patient for
administration within 24 – 48 hours
 After shipment, SP bills insurer for drugs
 MD bills insurer for drug administration
only
Oncology – A Too Quiet Success
Story

Other SP and PBM success were in less
complex specialties
 Oncologists Do:





Manage comprehensive multispecialty care
Understand old and new treatments and toxicities and
side effects
Balance drug choices on multiple decision trees
Manage adverse outcomes
Provide patient education and support, case
management
What are issues in oncology re
specialty pharmacy?









Distribution Cost, Reliability, Safety
New and Combination Therapies drive cost, not
correctable purchasing decisions
Waste and Inefficiency
Risk
Focus on Drug Prices without considering cost of
professional services is short-sighted
Oncologist becomes Primary Caregiver, specializing
in Care Coordination
Medical Decision-making in Oncology Needed by
Physicians familiar with the Patient
No Visa, No Drug
Redundancy and Malpractice
Distribution Cost, Reliability,
Safety
A
generic is not the same for quality and
useability
 Price is the last deciding factor
 You get what you pay for (short dated,
improperly stored, adulterated, counterfeit)
 Risks and Liability too great
 Extra Steps and Players mean extra
confusion, = Extra Risk
New and Combination Therapies
drive cost, not correctable
purchasing decisions
 Medical
Effectiveness
 Toxicities
 Combination Regiment change above
 Rapidly changing rules and status
 Single source, multi source, few generics
 Discounts increasingly hard to come by
Waste and Inefficiency







Single centralized inventory
Each drug compounded re Pnt height, weight, physical
condition and dose intensity of other drugs in regimen
Daily patient health status changes
Waste
Duplicate storage
Non returnable product
“A dispensed drug for one patient cannot be used on
another patient, so it should not be placed into the
general office stock under any circumstances….The
drug would be considered adulterated under Chapter
499, F.S.,” Jerry Hill, RPh, CPh, chief of pharmacy
services for the Florida Department of Health.
Risk

Waiver of liability
 Malpractice coverage
 Interference with clinical controls and the direct
communications that allows the medical care team to
ensure the safety and use of drugs.
 MVI Breaks the chain of custody, imposes unnecessary
and dangerous delays in treatment
 Payors may be held criminally liable for violation of the
Federal Food, Drug, and Cosmetics Act (FFDCA) if,
even if unbeknownst to them, drugs obtained from other
countries by vendors were dispensed to health plan
enrollees and paid for by their insurer.
Limited Program Successes
Brownbagging starts and stops – Illinois, Fla,
Virginia, CT
 Experience –





Waste – Millions of dollars of double insurer
payments for unused drug
Treatment delays – late arrivals, wrong shipments
Liability – “hold harmless” clauses
Non oncology specialties – dermatologists,
rheumatologists, gastroenterologists and neurologists
may embrace for lack on infrastructure themselves
Our Future
Evidence Based
Medicine
Value Driven Healthcare
“Proving It”
5/23/2017
History of “Quality” Measurement Programs
 In
other specialties such as cardiology and
endocrinology (diabetes management)




CMS
Private Payers
Quality Organizations
Hospitals
 Learning



Curve = Communication Issues
American College of Cardiology. See http://www.acc.org/qualityandscience/quality/quality.htm Accessed August 9, 2007
American Diabetes Association. See http://docnews.diabetesjournals.org/cgi/content/full/2/8/4#REF1 Accessed August 9, 2007
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe
5/23/2017
Oncology Quality Studies

The landmark 1999 Institute of Medicine (IOM) report "Ensuring
Quality Cancer" raised concerns about the quality of care provided
to cancer patients and the lack of systems to assess quality.1

Feb 1, 2006 The National Initiative on Cancer Care Quality
(NICCQ), which analyzed data from nearly 1,800 patient surveys
and medical records of people with early-stage breast and colorectal
cancer, found that the large majority of patients are receiving highquality care, though certain areas of care are in need of
improvement. ²

1Hewitt


M, Simone JV: Ensuring Quality Cancer Care. Washington, DC, National Academy Press, 1999
²The Quality Oncology Practice Initiative : Assessing and Improving Care Within the Medical Oncology Practice ,
Kristen McNiff, MPH , Journal of Oncology Practice, Vol 2, No 1 (January), 2006: pp. 26-30
© 2006 American Society of Clinical Oncology. http://jop.ascopubs.org/cgi/content/full/2/1/26
5/23/2017
What can be Quality/Value
What treatment “does” for a patient
 Transparent
 Reductions in Variation
 IOM:







Safe
Effective
Patient-centered
Efficient
Equitable
Timely
Committee on Quality of Health Care in America, Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century,
page 5 of the Executive Summary, Washington, D.C., The National Academies Press, 2001. Accessed August 9, 2007.
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30
5/23/2017
Performance/Quality/Value is a
matter of perspective…..
5/23/2017
Current “Quality” Programs – in infancy and very
limited in scope
CMS
 Data needs to be quantifiable



Non-oncology Demonstration Projects
2005, 2006 Oncology Demonstration Projects
2007 Physicians Quality Reporting Initiative
Private Payers
 Often based upon claims data



Non-oncology pay for performance program
Reporting to members physician “quality” rankings
Varying co-payments and deductible incentives for plan members for choosing
“quality” physicians
ASCO QOPI Initiative
 Early stages of implementation


Practice Specific Use
Voluntary
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30
5/23/2017
Trends In Private Payers – Oncology no
longer business as usual, but rarely P4P




Assumption of ASP + x%
 With or Without professional service adjustments
 Without recognition of ASP flaws
Specialty Injectables Programs
 Issues: Quality, Cost, Access to Treatment, Care
Delays, Medical Decision-making if formularies
involved
Blanket Prior Authorizations
 Mother May I – Medical Decision-making Issue,
plus care delays, cost burdens
Insertion of Care Management Entities
 Affecting site of care and talking to patients outside
of MD/Patient loop
 Disease Management, Oncology Management
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn
Holcombe, Oncology Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue,
Pages 26 – 30.
5/23/2017
Where are we re P4P?
 Lots
of fanfare, little actual happening re
oncology
 Over use and under use focus
 Disease management programs stop and
start fitfully
 Pilots will build in 2008 and 2009, different
approaches
 No national solution
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe,
Oncology Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
5/23/2017
Initial Efforts
 CMS
Physician Quality Reporting Initiative
(PQRI)
 United
 PA
5/23/2017
– Horizon, Highmark
Is the Government Paving the
Way?
 PQRI
measures include oncology
 Rough estimate less than half of practices
participating
 Design flaws

Proves issues with cart before the horse
 Lesson:
Practice, Incur Costs, and expect
no money (not auspicious)
5/23/2017
P4P or Value in Care – Cloudy
Waters?
 Measurement
and Data difficulties
 Technology Challenges
 Imbalance and errors in drug and
professional services payments
 Intrusion of third party entities
 Core Patient – MD interaction
 This is Cancer Care
5/23/2017
Pay for Value – A Growing Concept




Value for patients – results and outcomes
Perspectives may differ strongly between MDs and
payers
Health outcome per dollar of cost expended
Value measured over care cycle, not per unit





Avoidance of interventions
Ongoing management to forestall recurrence
Local may not be the best value
Competing on results – measured and widely available
Migrate patients to truly excellent providers


Competition on results, not standardized care
Shift strategies, structures and processes to measure and
improve results
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
“Is your practice ready for an uncertain future? The questions you should be asking your staff” By Dawn Holcombe , Community Oncology,
VOLUME 3, NUMBER 3 (March 2006)
5/23/2017
Preparing to Prove Value in Oncology
 Education
 Assess/Strategize/Plan
 Standardize
 Network
 Partner/collaborate
up and down the
continuum of care
 Measure
 Document
 Build value portfolio
“Pay
for Performance & Oncology Practices, At the Crossroads,
What
Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
5/23/2017
DGH
Consulting
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
Aren’t we ready to Prove Value?




Traditional reports (volume, staffing, flow, case mix,
drugs, regimens, financials)
EMR level reports (tx by stage, drugs, standards, some
guidelines, symptoms, history, etc.)
Taken for Granted (disease management, complication
avoidance, reviews of alternatives, patient support, etc.,
responsive action)
Invisible (questions not even thought of yet, but integral
to care) If you pay, but not reimbursed, for What Value?
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
5/23/2017
Oncologists Provide Quality but now think
“Value” internally and externally
Common Practice and even services must be catalogued, measured,
valued, and marketed

Incoming/outgoing phone calls (reason and resolution)

Avoided ER visits and hospitalizations

Admissions and Readmissions per cancer case

Prescriptions and resulting outcomes

ER visits/hosp. Admissions Counted, identify reason, followup

Conversations re EOL, hospice, palliative care

Disease and Symptom management steps, coaching and
counseling documented every time

Proving Value may still not be enough in times of limited
resources
“Pay for Performance & Oncology Practices, At the Crossroads , What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology Issues , published by
the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
“Is your practice ready for an uncertain future? The questions you should be asking your staff” By Dawn Holcombe , Community Oncology, VOLUME 3,
NUMBER 3 (March 2006)
5/23/2017
Oncology Stepping Up - QOPI

The Quality Oncology Practice Initiative:
Frequently Asked Questions
Q: What is the Quality Oncology Practice
Initiative?
 A: The Quality Oncology Practice Initiative (QOPI) is a
quality improvement program based on retrospective
chart reviews conducted within oncology practices.
QOPI includes a set of oncology quality measures, a
specified chart selection strategy, a secure system for
data entry, automated data analysis and reporting, and
a network of resources for improvement.


The Quality Oncology Practice Initiative : Assessing and Improving Care Within the Medical Oncology Practice ,
Kristen McNiff, MPH , Journal of Oncology Practice, Vol 2, No 1 (January), 2006: pp. 26-30
© 2006 American Society of Clinical Oncology. http://jop.ascopubs.org/cgi/content/full/2/1/26
5/23/2017
Q: What are the QOPI quality measures?

A: Practicing oncologists and quality experts developed and update the
QOPI measures, which are














derived from clinical guidelines or published standards
adapted from the National Initiative on Cancer Care Quality (NICCQ)
consensus based and clinically relevant
Areas addressed by the current QOPI measures include
end-of-life care
appropriate chart documentation (e.g., staging, pathology report, chemotherapy consent)
pain assessment and control
antiemetic administration
erythroid growth factor administration
hormonal therapy administration (breast cancer patients)
adjuvant chemotherapy administration (breast and colorectal cancer patients)
granulocyte growth factor administration (lymphoma patients)
The Quality Oncology Practice Initiative : Assessing and Improving Care Within the Medical Oncology Practice ,
Kristen McNiff, MPH , Journal of Oncology Practice, Vol 2, No 1 (January), 2006: pp. 26-30
© 2006 American Society of Clinical Oncology. http://jop.ascopubs.org/cgi/content/full/2/1/26
5/23/2017
Outcomes, processes, measures?

QOPI measures processes of care—one of the three components of
quality, along with environment of care and outcomes of care
(Donabedian A. JAMA 260:1743-1748, 1988). With a potentially fatal
illness, most would define the highest quality as that which achieves
the best survival. For that reason, we should focus on outcomes
such as survival. However, with cancer, in which improvements may
not show up in the survival measurements for years, quality
improvement efforts must focus on assessing and improving care
processes that have been previously demonstrated (either in
randomized clinical trials or other methods) to enhance survival.

Defining Quality: QOPI Is a Start , Douglas W. Blayney, MD Editors Desk, Journal of Oncology Practice, Vol 2, No 9 (September),
2006: © 2006 American Society of Clinical Oncology. http://jop.ascopubs.org/cgi/content/full/2/1/26
5/23/2017
Quality Care – In Process

Patients with early-stage breast cancer received 86% of generally
recommended care, based on 36 quality-care measures, while patients with
early-stage colorectal cancer received 78% of generally recommended
care, based upon 25 quality-care measures. These overall rates of
adherence suggest that the quality of care for cancer is better than that
observed for other chronic medical conditions.

The study — commissioned by the American Society of Clinical Oncology
(ASCO) and undertaken by researchers at the Harvard School of Public
Health and the RAND Corporation — showed strikingly higher adherence
than anticipated to processes of care believed to be essential for improving
patient outcomes.

DETAILED RESULTS RELEASED FROM FIRST-EVER NATIONAL STUDY ON CANCER CARE QUALITY IN THE UNITED STATES, Press Release for January 31,
2006, The Rand Co., http://www.rand.org/news/press.06/01.31b.html
5/23/2017
The Obvious “Holes” in Professional Rates –
might be indicators of Quality












Pharmacy Facilities (Drug inventory, acquisition and handling costs)
Oncology Treatment Planning
Patient Coaching, Counseling and Education
Patient symptom Management/triage re urgent care
Nutrition, Social services
Screening and Prevention
Fully Informed Patients
Management of Imaging and End of Life
Enrollment in Clinical Trials
Determination of preferred treatments and drugs
Pharmacoeconomic analyses on regimens/treatments/even choices for
palliative care vs treatment
Management of Hospitalization and ER Visits/Avoidance
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology Issues ,
published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
“Is your practice ready for an uncertain future? The questions you should be asking your staff” By Dawn Holcombe , Community Oncology, VOLUME
3, NUMBER 3 (March 2006)
5/23/2017
Oncology Scorecard Ideas

Phase I – Basic Oncology Measures

Documented stage and diagnosis, stages from the AJCC version 6
• % compliance reported quarterly

Documented line of therapy, 1st, 2nd, 3rd, 4th and higher
• % compliance reported quarterly

Documented patient performance status at every visit, NED, SD, PD,
PR, CR type nomenclature
• % compliance reported quarterly






Recurrence
Local or distant
ER visits
Admissions
Readmissions
Symptom occurrence and prevention
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
5/23/2017
Oncology Scorecard Ideas continued

Phase II – Quality Care Indicators

Assessment of fatigue, nausea, and pain
• % compliance reported quarterly

Assessment of depression and anxiety measures
• % compliance reported quarterly

Written consent obtained for all therapies
• % compliance reported quarterly

EOL: Hospice discussion and Advanced Directive discussion for
all Stage III and IV patients documented
• % compliance reported quarterly

Clinical trials considered for all Stage 4 patients
• % compliance reported quarterly
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
5/23/2017
Oncology Scorecard Ideas:
Further Phases

Phase III – Standards and Outcomes

Adoption of Evidence-Based Guidelines
(identify and show compliance for one - Colon) NCCN
• % compliance reported quarterly

Adopt and use standard delivery of chemotherapy regimens
• % compliance reported quarterly

Adopt and verify compliance with safety guidelines NIOSH
• % compliance reported quarterly

Adopt and use standard Anti-Emetic Guidelines ASCO/NCCN
• % compliance reported quarterly
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
5/23/2017
Oncology Scorecard Ideas:
Further Phases
continued

Phase IV – Standards and Outcomes – Advanced

Expand symptom/side effect measures to all 4 parameters of
psychosocial distress: physical symptoms, psychological, social, and
spiritual
• % compliance reported quarterly

Adopt and show compliance for other cancers (breast, lung, prostate,
lymphoma, and ovary - 80% of all chemo used) NCCN
• % compliance reported quarterly

Generation of family history with approach to risk counseling and testing
• % compliance reported quarterly

Develop and adopt guidelines for follow-up for patients after cancer
NCCN
• % compliance reported quarterly
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology
Issues , published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
5/23/2017
P4P in Oncology?
 Limited



Localized
A lot of data gathering
Few dollars have actually changed hands
 P4P




Pilots –
a misnomer?
Reduction of hassle factor
ROI undefined
Measures undefined
Preferred ranking
5/23/2017
External or Internal
Development

The Core


The Barrier


Technology and data
The Key



Patient-MD relationship
Collaboration and communication - MD to Payer
Building Bridges
It will take both, but external entities’ value in
question
5/23/2017
The Core
 Intimate
knowledge of patient individual
disease, health status changes, family and
supportive care
 MD/Nurse available 24/7 in community
oncology
 Pnts get confused easily re cancer, too
many points of contact detrimental to
health/treatment
5/23/2017
The Barrier
 Technology

Can’t rely on EMR penetration in short time
 Variation


the norm
Unintended
Knowledge will reduce, not punishment
 Data


Silos – payer, provider, patient
Trust, PHI
5/23/2017
The Key
 Numerous
Initiatives started around
practice collaboration and tracking of data
 Practice/provider collaboration and
tracking
 Provider networks
 Education,
trust and awareness cannot be
understated…progress requires all
5/23/2017
Value Portfolio

Individual to practice

Prove process, review, analysis, and change and especially
outcomes

www.clevelandclinic.com/quality

http://www.clevelandclinic.org/quality/outcomes/hematologyA
ndOncology/default.htm

Answers to “invisible” or assumed questions, what we have
taken for granted
“Pay for Performance & Oncology Practices, At the Crossroads, What Your Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology Issues ,
published by the Association of Community Cancer Centers (ACCC), March/April 2007 issue, Pages 26 – 30.
“Is your practice ready for an uncertain future? The questions you should be asking your staff” By Dawn Holcombe , Community Oncology, VOLUME 3,
NUMBER 3 (March 2006)
5/23/2017
“Only those who see the invisible,
can do the impossible”, Anonymous
5/23/2017
Attachment: Key Players in Quality











National Committee for Quality Assurance (NCQA)
http://www.ncqa.org
Bridges to Excellence (BTE)– health plan and purchaser program
for select providers http://www.bridgestoexcellence.org/
AMA Physician consortium for Performance Improvement – 70
national medical societies Seen by CMS as leading organization
to drive policy
The Leapfrog Group www.leapfrog.org
National Quality forum (NQF) http://www.qualityforum.org/
Ambulatory Care Quality Alliance (AQA) – NCQA, AMA
Consortium, and NQF – along with CMS and AHRQ
Integrated Healthcare Association (IHA) quality initiative in CA
http://www.iha.org
Disease Management Consortium
Academic Professional Societies such as ASCO and NCCN
Community Oncology Alliance
Cancer Clinics of Excellence
5/23/2017
Resources

“Dangerous Doses: How Counterfeiters are Contaminating America’s Drug
Supply” by Katherine Eban, 2005 Harcourt Press

“Is Oncology Compatible with Specialty Pharmacy?” By Dawn Holcombe,
Community Oncology, VOLUME 2, NUMBER 2 (March/April 2005)
http://communityoncology.net/journal/articles/0202173.pdf

“Redefining Health Care: Creating Value-Based Competition on Results”,
Michael Porter & Elizabeth Teisberg, Harvard Business School Press, 2006

“Pay for Performance & Oncology Practices, At the Crossroads, What Your
Oncology Practice Can Do Today”, By Dawn Holcombe, Oncology Issues ,
published by the Association of Community Cancer Centers (ACCC),
March/April 2007 issue, Pages 26 – 30.

“Is your practice ready for an uncertain future? The questions you should be
asking your staff” By Dawn Holcombe , Community Oncology, VOLUME 3,
NUMBER 3 (March 2006)
5/23/2017
Final Words







MD-Patient-Payer Triangle
Network, Collaborate, Pilot
Do Not minimize complexity of oncology
Process is more important than outcomes at
start
Evolution will lead to outcomes
Aggregate Value Information and Initiatives
War on Cancer – Derail or On Track?
5/23/2017
Thank You, and Good Luck
Dawn Holcombe, MBA, FACMPE, ACHE
DGH Consulting and
Connecticut Oncology Association
33 Woodmar Circle
South Windsor, CT 06074
860-305-4510
860-644-9119 fax
[email protected]
5/23/2017