Oncology Pharmacists’ Role in Value- and Quality-Based Patient Care
Amy H. Seung, PharmD BCOP
Senior Medical Director
Pharmacy Times Continuing Education
Ellicott City, MD
Over the past several years, oncology practice in the United States has moved away from a fee-for-service model to a fee-for-value model. Value-based contracts are much more prevalent now, and reimbursement is becoming more dependent on patient outcomes. This movement has changed the dynamic of oncology care across all types of practices. Often, appropriate medication management is necessary to ensure the success of a value-based arrangement. Increased pressure is being placed on all stakeholders—from practice administrators to payers—to improve medication efficiencies, especially in such areas as antineoplastics and biologics. Organizations must maintain the financial strength of their practices while concomitantly demonstrating improved patient outcomes.
Oncology pharmacists occupy an influential position in these new models because they participate both in creating medication guidelines and policies in their organizations and in evaluating high-volume and high-cost medications on the formulary. The role of pharmacists is evolving as organizations use them to improve medication adherence and reduce readmissions, a key metric in many value-based payment arrangements.
More research evaluating pharmacists’ roles in improving these specific patient outcomes has been published in the area of primary care; however, oncology pharmacists are also publishing in this area. In 2018, Vulaj and colleagues published research on an assessment by three pharmacists of 200 Quality Oncology Practice Initiative (QOPI) measures on which pharmacists could potentially have an impact; of 177 measures, 67 (38%) were identified as ones with outcomes that pharmacists could influence. These measures were related mainly to optimization of medication therapy through the development and implementation of guidelines. Patient counseling and symptom management were also identified as metrics that could be completed by pharmacists.1 Two HOPA members, Shannon Hough, PharmD BCOP, and Emily Mackler, PharmD BCOP, were part of this study and authored the publication.
In response to HOPA members’ interest in the value and quality of care for cancer patients and in the rapidly changing landscape of oncology reimbursement and quality measurement, HOPA formed the Quality Oversight Task Force following its 2018 annual conference. The task force was charged with incorporating healthcare quality and value into HOPA’s strategic initiatives, specifically by attending to quality improvement; making recommendations in such areas as standards, research, and external relations; and making recommendations to HOPA’s board of directors.
One of the first tasks of the group was to complete a baseline assessment of quality-focused work being done both within HOPA and in cooperation with external organizations. Committee leaders and HOPA liaisons for external relations completed the assessment. The group found that a substantial amount of work on quality and value is being completed across 28 committees representing the four pillars of the organization. However, the group also noted that HOPA needs to do better as an organization in coordinating efforts in the areas of value and quality of care. The development of partnerships and collaborations with other oncology and pharmacy organizations in efforts related to the value and quality of care will be crucial.
Those participating in the assessment were asked several questions. In response to the question “How would you rate HOPA’s engagement with or focus on the quality and value of cancer care?” only 50% of committee leaders rated it as excellent or above average. When asked “How would you rate your own knowledge and skills on the quality and value of cancer care?” more respondents rated their own knowledge as excellent or above average, but 43% of the committee leaders stated that their knowledge was only average. To the final question, “How would you rate our overall membership’s knowledge and skills in this area?” respondents answered excellent (4%), above average (29%), average (61%), and below average (7%). The responses to this survey constitute a further call to action for HOPA and the Quality Oversight Task Force to work on new ways to increase members’ knowledge, strengthen HOPA’s research and advocacy efforts, and support members in their professional practices in this area.
Following the baseline assessment, the task force prioritized several action items, giving consideration to their scope, feasibility, reach to the membership, resources needed, and time to execute. One action item is to provide HOPA members with appropriate resources and tools, given the wide continuum of roles and responsibilities carried out by oncology pharmacists in their practices. HOPA members need to be able to incorporate quality measures in their documentation of everyday interventions in their standard workflow. Other action items are to help members routinely benchmark their work against metrics and to provide for them focused live education and training on evaluating quality metrics and conducting quality-based research initiatives.
The task force is currently evaluating a number of training programs provided by other organizations. One is the American Society of Clinical Oncology’s Quality Training Program (QTP). The program is designed to train oncology healthcare providers in a multidisciplinary team-based setting to investigate and implement data-driven quality-improvement processes, as well as manage clinical and nonclinical processes and outcomes. The program combines coaching, peer-to-peer mentoring, and shared learning approaches with experiential learning techniques effective for solving problems related to quality of care. Several HOPA members have completed this program with their organizations, including George Carro, MS BCOP, director of oncology pharmacy services at NorthShore University HealthSystem near Chicago, IL. One of NorthShore’s projects involves reducing financial toxicity for patients in the ambulatory oncology setting, with a main goal of providing education for patients and engaging in informed discussion with them prior to making treatment decisions. The group wanted to evaluate patient-reported outcomes and the effects of high-cost therapies, such as immune checkpoint inhibitors, on the institution. Several other oncology pharmacists have participated in quality training programs in their organizations, and their experiences will be highlighted over the next year. The ASCO QTP library shares information on past projects, which can be a resource for idea generation.
HOPA’s Quality Oversight Task Force continues to plan the development of specific resources and education for members. In addition, opportunities both for members to be engaged and for HOPA to build depth in this area are being assessed.Oncology pharmacists are in a unique position to contribute significantly to quality and value metrics in the care of patients with cancer. The pharmacist’s role as part of multidisciplinary teams, including providing oversight for coordination of care for individual patients in conjunction with a systemic view of medication management, is significant. Pharmacists understand the need for standardizing medication practices in order to improve efficiencies and contain costs. Our roles will continue to evolve in this area, and we must be ready to show the value of the care we provide to our patients.
- Vulaj V, Hough S, Bedard L, Farris K, Mackler E. Oncology pharmacist opportunities: closing the gap in quality care. J Oncol Pract. 2018 June;14(6):e403-e411.