2018 was a year of upheaval in healthcare – the opioid crisis reached an alarming level, e-commerce giant Amazon revealed clear intentions to enter the healthcare arena in a meaningful way, and CRISPR gene editing technology was reportedly used to modify the genetic makeup of a human embryo. In this dynamic environment, what can we expect in oncology in 2019? Here are a few specific predictions to note in the field of cancer treatment and research…
At the end of 2018, the Oncology Care Model from CMS will reach the midpoint in its planned 5-year timeline. The clear expectation is this will give way to a new payment model – one that may even be mandatory, as recently signaled by HHS Secretary Alex Azar with regard to radiation oncology. All areas of healthcare are evolving to prioritize value over quantity of care delivered, and oncology is no exception. Moving to a value-based care structure requires that providers, payors, and patients have access to granular clinical data to truly understand what is adding value and what is not. By necessity, this data must be drawn from the vast stores of information gathered in the EHR and other 'messy' data sources.
While 2018 certainly witnessed the boom of telemedicine when it comes to primary care, behavioral health, and even urgent care applications, 2019 will witness this same transformation in oncology. If a cancer patient develops a new concern or is due for a routine check-in, imagine if this could happen through a telemedicine appointment. Not only would this help avoid the exhaustion and financial cost associated with a trip into the clinic, but it might reduce exposure to communicable illnesses in the waiting room.
Beyond relatively routine interactions, there is growing recognition that many medications – even certain types of anti-cancer agents – may be safely administered at home or in lower intensity settings. By providing these options to patients when they are available, providers are able to deliver patient-centered care and optimize patient quality of life – and do so in a cost-effective way. Similar to what we've already witnessed in the dialysis setting, this shift to more convenient medical care is beginning to take place in oncology.
As artificial intelligence technologies advance, there's little doubt that in the coming years, sophisticated therapeutic and diagnostic applications will be offered routinely. The fact is, we're just not there yet. In 2019, we can expect to see more incremental and practical applications of AI that help free up providers' time for the more complex services they are best-positioned to deliver. This may manifest as an AI device in the exam room that listens in to help start the doctor's note, or a smart AI system that queues up refill authorizations for docs rather than the office staff having to do this. While there is plenty of hype around AI replacing the clinical role of physicians, this is not prime time. When it comes to routine, repetitive tasks, this is where AI technology will begin to be helpful to providers, at least in 2019.
In 2018, we heard about concerns from clinicians, patient advocates, and even regulatory bodies that clinical trial results may not always reflect the experience of patients treated on a routine basis. In the clinical trial arena, there is a set of consensus measures used to reliably assess patient outcomes. In the real world, physicians consider a wide variety of subjective and objective indicators to determine whether a treatment is working. They may put as much faith in the answer to a simple question like "How do you feel?" as in a laboratory result. In order to apply population-level real-world data to regulatory decisions, it becomes critical for all stakeholders to agree on the right endpoints. In the real-world, how do you measure "success"?
The FDA announced this month that it hopes to advance the use of real-world evidence to support the development of drugs and expand the understanding of how these products work outside of the clinical trial realm. To help address this void, earlier this year Friends of Cancer Research compared the outcomes of real-world patients across multiple data sources and published clinical trial data. The work explored different real-world outcome measures with an eye toward identifying strengths and weaknesses of the various options. COTA was one of 6 organizations to collaborate on this project. These efforts are by no means complete, and we expect these initiatives and similar efforts to continue across the industry in 2019 as we seek to better understand real-world patient experiences and outcomes.
The end of the year is typically the time to reflect on what has gone well, what you want to improve, and where you want to focus efforts in the New Year. With so much change happening in the industry now, we can't wait to see how these predictions will unfold – and where we may be right (or wrong) in our forecasts. As we continue our commitment to transforming cancer care and ultimately helping physicians save cancer patients' lives, we are encouraged by progress in 2018 and hopeful for what's to come. Be sure to follow our blog throughout the year for key updates in these areas and others that we believe are shaping oncology care.