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TRANSCRIPT
CAN TEAM
A Peak at 2017…
Capitol Hill, Oncology Issues & COA Priorities
Ted Okon
Monthly CAN Call
12/8/2016
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CAN Co-Chairs
▪ Kim Woofter• Michiana Hematology Oncology
▪ Maryann Roefaro• Hematology Oncology Associates of Central New York
Reminders
▪ The audio portion of the call will be recorded. Playback instructions will be sent later.
▪ Callers will be muted once the call begins. Toggle between mute and unmute with *6.
▪ Please do not place our call on “hold” while unmuted.
Welcome!
▪ Naycherie Alvira• Cancer Care Center of Frederick
▪ Shirley Lee
• Skyline Urology
▪ Colin Chambers • Advanced Centers for Cancer Care
▪ Part B “Experiment” effectively dead
• Outgoing Administration can still introduce the final rule but an
exercise in futility
▸ Both incoming Trump Administration and Congress can kill it
• Proves once again that a hard, dedicated fight can win the day
▪ CVS Caremark has reversed its decision to kick dispensing
practices out of network
• Not letting new practices in but we are trying to tackle that
▪ HHS/CMS/CMMI turned on its head
• Entire overhaul of political leadership; more severe than ever before
• “Career” staff besides themselves; resumes filling the air
What We Know For Sure
5© 2016 Community Oncology Alliance
▪ Involved in spearheading multiple letters from Congress to CMS
▪ Major national radio ad campaign supported by print and digital ads, mailers, SM targeting
specific members of Congress
▪ Developed/hosting 2 dedicated websites for providers & patients
• www.cancerexperiment.org
• www.StopCMSCuts.com
▪ Major OpEd campaign
▪ Generating national and local media coverage
▪ Worked with congressional committees on
several approaches to stopping this experiment
on seniors’ cancer care
▪ Met with CMS/CMMI leadership
▪ Testified at 2 congressional hearings
▪ Made it an election issue with 3 major Senate campaign ads about it
What COA Did
6© 2016 Community Oncology Alliance
© 2016 Community Oncology Alliance
Print & Digital Ads In DC Metro Market
▪ Obamacare is in the crosshairs for repeal and replace but…
• What exactly will get repealed?
▸ Will it include CMMI?
○ What happens to the OCM?
• What exactly will replace it?
▸ When will it be replaced?
○ Right away?
○ 1-2 years?
○ 3 years?
• Will the GOP come together on what to repeal and replace?
• What will and can the Democrats do?
• How will it get repealed and replaced without 60 votes in the
Senate?
What We Don’t Know For Sure
8© 2016 Community Oncology Alliance
▪ How will the new political order in DC differ from the old order
in terms of cancer care?
• Should be less likely to advance policy and regulations that foster
more consolidation of healthcare, including oncology
• Should be more prone to strip away regulation
• Should be more receptive to the issues impacting community
oncology
▸ Why?
○ Part B
○ Sequester
What We Don’t Know For Sure But Can Guess
9© 2016 Community Oncology Alliance
▪ Fixing aspects of Medicare drug reimbursement
• Revisiting the sequester cut
• Prompt pay discount issue
▪ Keeping the hospitals “honest”
• 340B
▸ Tied to addressing the drug price issue
• Payment site neutrality
▪ Keeping the PBMs really honest
• DIR Fees
• Playing doctor
• Self serving steerage
▪ Advancing oncology payment reform
What Are COA Priorities in DC for 2017
10© 2016 Community Oncology Alliance
11© 2016 Community Oncology Alliance
▪ Fix ASP-based reimbursement
• Stop the sequester cut from being applied to cancer drug payment
• Eliminate prompt pay discounts from the calculation of ASP
▪ Neutralize hospital payment advantages and aggression
• 340B fixes
• Site neutral payments
▪ Stop PBMs from dictating treatment
• Roll back DIR fees and create greater transparency
▪ Advance oncology payment reform
• Support reintroduction of H.R. 1934 and S. 3122
• Make it work!!!
Top Legislative Priorities for COA in 2017
12© 2016 Community Oncology Alliance
▪ 340B in the crosshairs – Question is, “How long
does the bubble expand?”
• There is actually legislative language to increase
transparency and accountability
▪ HOPPS final rule out implementing first step in
site neutral payments
• Result of the Bipartisan Budget Act of 2015
• CMS held pretty firm in actually operationalizing
payment cuts (50% or so)
• Gave in on existing (grandfathered) facilities
expanding services and still billing under hospital
fees
• Hospitals fought to get some relief in CURES bill
• More push-back on hospital consolidation of
practices and financial impact at federal and state
levels
Site Neutrality & 340B
▪ CVS Caremark moved to shift all dispensing practices to “out of network” for
Medicare Advantage plans effective January 2017
• Indications were that Express Scripts was ready to follow CVS lead
• Massive practice, media, and state/federal legislative effort stopped CVS
• CVS recently reversed its decision; still not allowing new dispensing practices into the
network
• COA not letting up with letter to CMS (now outgoing) head Andy Slavitt
▪ Absurd (and I mean ABSURD) DIR fees
• Charge what they want, how they want, when they want
▪ Express Scripts tightening ”formulary” and steering business to Accredo
▪ With more oral oncolytics coming out of the pharma R&D pipeline, expect
more attempts to capture this business
• They will go after not only dispensing practices but those with retail pharmacies
PBM/Specialty Pharmacy Issues
13© 2016 Community Oncology Alliance
▪ Hired legal firm specializing in pharmacy issues to fight for
community oncology
• Legal letter to CVS
• White paper on PBMs featuring CVS
decision
• State and federal congressional outreach
on CVS
• Patient outreach on CVS
• DIR white paper in the works
• Much more
What is COA Doing?
14© 2016 Community Oncology Alliance
PharmacyBenefitManagers’AttackonPhysicianDispensing
andImpactonPatientCare:CaseStudyofCVSCaremark’sEffortstoRestrictAccessto
CancerCare
Preparedby
FrierLevitt,LLC
CommissionedbytheCommunityOncologyAlliance
August2016
15© 2016 Community Oncology Alliance
▪ Make the OCM successful – in spite of CMMI!
▪ Develop the OCM 2.0
• What the OCM should be
• Universal model that can be adapted by payers and employers
▪ Dialogue/Outreach more to employers on oncology payment
reform
▪ Aggressively expand COA’s patient advocacy network
▪ Create greater identify for community oncology
• I AM Community Oncology
Top Practice-Facing Priorities for COA in 2017
▪ Private insurers have already started years ago• United, Aetna, Anthem, Priority, etc.
▪ Medicare COME HOME project already done
▪ Oncology Care Model (OCM) is now rolling• 196 practices implementing it (or trying!)
• Payers at all different levels of readiness
▪ MACRA final rule out and the implementation clock is ticking• Need to make choices now
▪ Both sides of the political aisle want “value” in payment for medical
services and drugs
▪ Community oncology needs to be even more agressive in moving on
payment reform!!!
Oncology Payment Reform
16© 2016 Community Oncology Alliance
▪ Help practices make the OCM really work
• Have 70% of the practices networked
▪ Provide materials to help facilitate implementation
▪ Created peer-to-peer information exchange
• Dedicated listserv
• Affinity groups
• Meetings and calls
▪ Brought on very experienced experts (Kavita Patel,
MD, Basit Chaudhry, MD, Laura Long, MD)
▪ Proactive outreach to CMMI on implementation
issues
▪ Evolve the model as needed so it actually works and
can be used elsewhere
• OCM 2.0
• Create an AAPM version
▪ Use House (H.R. 1934) & Senate (S. 3211) bills to
leverage CMMI
COA Oncology Care Model (OCM) Strategy
17© 2016 Community Oncology Alliance
▪ MIPS is going to be a real crapshoot in terms of where you land
• Can’t just ignore it because a severe downside penalty (9%!) is out there in later
years
• Make a wise decision for 2017 because that’s the baseline measurement year for
2019
• Get your house (practice) in order NOW!
▸ Understand what you will be measured on and put new procedures in place as needed
• Putting your head in the sand is the worse thing you can do!
▪ Future of community oncology may be in advanced alternative payment models
(AAPMs)
• Good news is they offer 5% bonuses plus upside of the model savings
• Bad news is you are going at risk
• Need to incorporate actuarial expertise into your thinking
• Can’t put your head in the sand on this one either!
My Thoughts on MACRA – MIPS and AAPMs
18© 2016 Community Oncology Alliance
19© 2015 Community Oncology Alliance
2017 Community Oncology Conference
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Thank You!
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Ted Okon
Twitter @TedOkonCOA
www.CommunityOncology.org
www.MedicalHomeOncology.org
www.COAadvocacy.org (CPAN)
www.facebook.com/CommunityOncologyAlliance
© 2016 Community Oncology Alliance