Ep. 20 Navigating Cancer Care in Uncertain Times with ACCC's Meagan O'Neill

How do we deliver high-quality cancer care in a system under pressure? Meagan O'Neill, Executive Director of the Association of Cancer Care Centers (ACCC), joins us to talk about workforce empowerment, technology as a multiplier, and building sustainable oncology systems for the future.

Meagan shares her journey from oncology business consulting to national advocacy, shaped by her own personal experience with cancer care. With two-thirds of U.S. cancer programs in its network, ACCC plays a pivotal role in driving change across the oncology landscape.

In this episode, we discuss:

• Why personal experience can reshape how we design cancer care

• Strategies to address workforce shortages through empowerment

• Using technology to amplify—not replace—clinical teams

• Building upstream cancer care capacity to improve community health

• Making value-based care real in oncology practices

• Interoperability and integrated models for better patient outcomes

• The role of diversity in improving adherence and patient engagement

Key Takeaways

• Workforce empowerment is essential to meet rising patient needs.

• Technology should act as a force multiplier for clinicians.

• Patient-centered care must be prioritized at every level.

• Interoperability and upstream investment are critical for sustainable oncology systems.

Introduction and Guest Welcome

Well, Amar, we're continuing a busy fall season of episodes here on Value Health Voices. This evening we have the pleasure of the executive director of the ACCC. The ACCC is the Association of Cancer Care Centers and we're joined with Meagan O'Neill. We're gonna dive into topics around oncology care for tomorrow's patient population, and we'll get right into it after the interim.

I've known Meagan now for over a year when she came into the role as the executive director for the Association of Cancer Care Centers, and I'm really excited that she's agreed to join us as a guest on this episode. She joined ACCC in July 2024 with over 15 years of experience serving as an oncology focused business consultant and strategic advisor to hospitals and health systems across the country. Prior to her joining ACCC, Meagan built and co-led the oncology services practice at ECG Management Consultants, a nationally recognized healthcare consulting firm and the nation's largest dedicated oncology consultancy serving the provider industry.

Over the last decade as a consultant, she has partnered with leadership teams with over a hundred different organizations to tackle their most pressing challenges and greatest opportunities within oncology. From operational improvement and performance transformations to strategic growth pursuits and partnership formations. Welcome Meagan, we're excited to have you with us.

Well, thank you for having me. I feel privileged.

Professional Background and the Evolution of the ACCC

So let me start with myself and then the transition to ACCC. For better or worse, I am a management consultant, tried and true. I've spent my past 10 years in oncology business consulting in particular. I had the privilege of working with a lot of different clients in both the community-based setting as well as academic institutions. The firm I worked for, we ended up collectively working for probably half the NCI centers over my time there and then a full range of different cancer programs in the community, from the solo practitioner—where they do still exist in oncology—to the rural hospital, all the way up to the very large regional health systems and even some of the multi-state national organizations.

I love the work. It really spanned strategy and operations. Think about the most challenging and complex issues that you have your C-suite at a hospital or at the cancer center facing; that's really what you're bringing consultants in to help you tackle and solve.

I was a member of ACCC myself for probably dating back about 10 years now. It historically, up until 2024, was known as the Association of Community Cancer Centers. It very much got its start within the community space, but I can't take any credit for the name change that happened in 2024, just before my joining. It was a big year in 2024. The organization celebrated its 50th year anniversary, its name change, and a leadership transition which I had the privilege of stepping in to take over for Christian Downs, who was the previous executive director for 30 years before me.

I knew the organization pretty well from my own experience turning to the various educational resources and learning oncology from the ground up over the years. But it was my experience in 2022 and 2023 on the caregiver side for the first time that was a really tragic experience. It was so eye-opening in the way that it was shocking, and I had that epiphany that I wanted to leave consulting and really look for an advocacy leadership role in a broader organization. A lot of the issues I was working on day to day are similar to what ACCC educates its members on, but I knew I would have the opportunity to make a broader impact and effect broader change in an association like ACCC.

Our membership today is about two-thirds of the country. Two-thirds of the cancer programs and practices in this country are within our network. It ranges really full spectrum, community and academic. We are uniquely serving a multidisciplinary cancer care team. It's really everywhere from your clinicians—or your clinicians with an administrative appointment more likely—and then the full gamut of your business operators, your managers of different departments, all the way to the clinical and the non-clinical supportive care staff. We have a large variety of roles that engage at an individual level and about 50,000 members.

The Personal Impact of the Cancer Care Journey

That's a great overview. As you were talking, especially about the part where you mentioned your management consulting experience, I was going to ask you about what problems you noticed are in common across those organizations. But then you mentioned your experience as a caregiver. I think we would be remiss to not start there because probably what you experienced with the healthcare system in that role is a great place to start and perhaps the most compelling place to start.

It's interesting in retrospect now, because at the time, it was so uncanny how the experience I was going through was everything I had really read about regarding the commonalities you see in a lot of patient decision making. This was for my stepmother, who was my mother my entire adult life. My birth mother passed away when I was younger, and so I call her my mom. She was very much a mother figure to me. She had a challenging situation, misdiagnosis, and an extended period of her not feeling well that lasted about four months. That quickly put her in an emergency room where she was diagnosed after about a two and a half week period with a stage four breast cancer right from the get-go.

We live outside of Washington, D.C., so immediately I was thinking there are three options where we're gonna go. We're very lucky we have three NCI centers in our neighborhood. But very quickly, my mom and my dad were like, "Meg, we're not going to the city." Driving to the city is a big deal when you live in the suburbs; it could be an hour or two with traffic. They just thought it was crazy that I was even suggesting that, and they wanted to get care in the local community they lived in, in Montgomery County, Maryland.

I was very close to the business side of cancer care and so did my due diligence to check out the practice. Two friends from their church recommended it. Once she got in and on her first hormonal treatment, it was the assurance that she was on something. It was doing its best to keep her cancer contained. We knew that within one to three, maybe five years if we were lucky, she would have to switch treatment. For her, it was just over about 12 months before her first line therapy stopped really working.

There was, luckily, a new branded drug that had been approved in the past year. It was for her exact type of breast cancer. We quickly heard that it got denied without rationale. That was the start of me realizing how much falls through the cracks for patients and their caregivers because I also hadn't seen cancer that up close and personal. She started to get really sick. After about two weeks of fighting with her doctor and fighting with the commercial insurance company that she had, we couldn't get through and then had to move to palliative care. But it wasn't even clear that we were moving into palliative care when we were entering that.

I had heard those conversations are hard to have with patients, but the whole thing I just found heartbreaking because it felt like we didn't have the support of a small, private community practice with only two physicians and an APP. Her APP functioned as our navigator, but it felt like we just didn't have the resources in the business office to maybe fight the denials and help that go through. I have shared this story before, but we were actually told to call a local senator's office because we were out of options.

That whole experience, I think a lot of us in cancer have experienced something that gives us strength and gives us the commitment to advance cancer care and to do better than we saw our family members get. I felt compelled to transition out of consulting, as much as I love that work, because I knew I wanted to do something closer to having the patient front and center and affect broader change.

What a deeply moving story. Thank you for sharing such a personal story and sorry for the loss of your mother. This is actually very personal to me because I used to practice in Montgomery County for 10 years before I moved to Annapolis. I know the community centers there; it's tough for them. They're struggling like everybody else is, and dealing with all these issues around denials and just being able to have that staff is so tough. For you to now, as head of an organization, be able to understand that from such a deep level is going to be so useful for all these other cancer centers going forward to have you advocate for them.

It resonated with everything I had learned and knew was the best practice, but it made me have this whole new appreciation for navigation. Seeing my mom talk about her nurse, her APP who functioned as her navigator because of resource constraints, she referred to her as her guardian angel. It made it all so much more personal. And then, of course, the prior authorization issues too. That was just really shocking because you see the statistics on how much those impact patient care stories, but actually feeling it and feeling like it had a role to play in the outcomes of my mom's cancer, it was just devastating. We still see how much that happens.

I just want to call out that point you made about navigation. Until people see how complex the US healthcare system is, and particularly how complex cancer care can be, navigation is often underappreciated as to what a key role it plays. Having the right reimbursement structures in place that value those wraparound services is just what your experience calls out right away.

Even with patient support groups, I had a whole new appreciation for seeing that through my mom's eyes and through the caregiver's lens. Pastoral care, the role of someone like a priest or a minister on the care team, became very important towards the end of my mom's journey. Seeing the different members that weren't clinical, but how much they actually had a role in the patient's journey, did give me this whole new sense of the multidisciplinary nature that is really what ACCC is focused on. Unfortunately, I don't think a lot of the business models have adapted yet to recognize that within the reimbursement and payment landscape.

Workforce Empowerment and Enablement

I think that's a nice segue to our first segment on workforce empowerment. Anthony, do you want to kick it off?

As workforce empowerment goes, one of the things that's making that such a critical issue—and I was thinking this as you were describing the story of your mother—is that with breast cancer and all the drugs that have come onto the market, patients with even metastatic cancer are living longer. So cancer incidence and survivorship are growing faster than our workforce and our infrastructure can support. Perhaps we could start if you could talk a little bit about how, in your experience and role in ACCC, APPs, nurses, and other team members can practice at the top of their license to really extend the reach and quality of the care that a cancer program can provide.

Workforce... I don't know about you all, but I feel like in the post-pandemic years everyone kind of got tired about hearing too much about the workforce, or about the rewards and penalties and how to culturally build your workforce. We heard that from our membership, that they were wanting a next level of discussion around workforce. So for this calendar year, as we were sketching out our educational areas of focus, we knew that workforce still comes up all the time with our members. But the way that we're really framing it at ACCC is about workforce empowerment and enablement.

My president at ACCC this year—we have one-year president terms—is Dr. Una Hopkins, who is a nursing and research leader at Montefiore Health System in the Bronx. She's an APP by nature. So there is a lot of focus around APP uplifting and the use of the APP workforce. I can't tell you how many communities I was in as a consultant where I would talk to the C-suite there and immediately it was around medical oncologists or needing to get in more oncologists. In some cases, there were APPs available there not working top of license.

We are helping different organizations to look beyond the oncologist. Not to diminish the role of the physician, but just the reality with physician shortages and oncology shortages is that those are here to stay. There's going to be an issue in bridging the gap between the booming silver tsunami and this growth in the cancer patient population. And as you brought up, the reality is that we have to start treating a portion of that like a chronic disease.

I think there's absolutely a larger role that we see organizations doing really well in, but it's not consistent across the board. The use of your APPs, the use of your pharmacists—I've seen really different things in the field with even how a pharmacist gets embedded in the outpatient side of oncology clinical care management. And then really the other members of the team as well, thinking about different levels of training and professional development. Those are topics we talk about a lot at ACCC, and also really continuing to talk about the strengthening of the workforce pipeline and how you can do that in creative ways and partnerships in your community. You're not going to be able to pay enough to get certain physicians there to bridge whatever gap you might have had in some places, so I think it's thinking about it differently.

Leveraging Advanced Practice Providers in Research

It's a great call out on the pharmacist piece. They are tremendous to our cancer program and really even functioning as strategic leaders coming up, helping us expand into new areas. Megan, you highlighted some stuff around the workforce pipeline, fellowship, and training models. I was wondering if maybe you can get into a little more detail with that, maybe talk about some of the innovative models and pipelines, like the APP Principal Investigators model.

That actually came to mind because ACORI is ACCC's Community Research Institute, and we usually hold an annual summit getting our stakeholders together. Last fall, one of the highlights of that summit was a session around APPs. Our speaker was an APP, but you've seen a few of the larger health systems in the community side really spring up these strong apprenticeship programs and focusing on the role that they can play in research. Often I understand that there is interest in becoming a PI and having more of an exposure to the research side. Una Hopkins, our own president, has a split hat between administrative and research leadership.

The focus around APPs and research has been a big discussion. We have several fall conference slots that were slated to talk about that and always in partnership with the other associations out there. We don't work in a silo. Under my leadership, I'm even forging more partnerships. So this is something we work on with organizations like APSHO and other known advocacy groups in that space.

Promoting Diversity, Equity, and Inclusion

Could you tell us a little bit about another issue that is related to workforce? I think firstly you have to get people who are trained and have the right experience in the right roles. But once you get there, perhaps the focus could be more on an advanced level, making sure there's a representation of diverse care providers given the community where a given program may be practicing. I've always found it tremendously compelling, these published data showing that patients are more likely to be adherent to their care plan and have better outcomes when their care provider may be from the same background as them. Is that a position that ACCC has been engaged in to try to drive workforce diversity?

Yes, definitely. Even with the changing tide in the political landscape throughout this calendar year, equity and inclusion and diversity—DEI—those are tenants that remain central to ACCC's core. We had in particular last year Dr. Nadine Barrett as our president, and her theme was around increasing diversity in the community, the workforce, and community engagement. We have really several different programs that usually are education. It tends to be more disease site specific, but we have a number of different types of screening and implicit bias training tools that we've seen be really effective in how to upskill your workforce or how to look differently for pulling in members of the community.

We've seen member organizations focus on DEI and really understanding their community and their community outreach army. It is, I feel like, at maybe a lower point than it was a year ago, unfortunately, just with the political landscape changes. But it's something that we continue to talk about a lot. We have an upcoming president in two terms, Renee Duffin from Mary Bird Perkins, and that Gulf Coast region has done really tremendous things with outreach. They think about how to leverage their community and to engage with the large employers to help have a pipeline that has representative samples—different community members that look like me and talk like me that can help relate to the patients. There's a really important element of that related to building cancer care programming upstream. Community engagement is really important for that.

Building Capacity and Scaling Operations

Megan, I'm thinking maybe we talk a little bit about capacity and building capacity. We're all providers on this phone, and our health systems have noticed that with the growing cancer patient population, we don't have the resources to just keep expanding clinic capacity. How do you see health systems being able to scale their operations to meet the needs of this growing cancer population, and what are the biggest opportunities to expand access without compromising quality?

It's a good question. I go back to my consulting work and 10 years in the field. I think at least half of the assignments I worked on were around partnerships. Some of those are the pure play, but more so it's really that development of the regional health system and truly digesting the growth that you saw through years and years of making a multi-hospital health system actually function like it has a central hub and connected spokes. But also importantly, the decentralization of the NCI center. We've seen that a lot through partnerships.

I think it's really important that we are decentralizing care so that we are putting outposts and building up community sites or community partners that are basically allowing cancer care to be closer to home. I go back to partnership and different ways to do that. There's tremendous innovation and diversity in the ways that you can do arrangements, and it doesn't always have to be financially integrated. I think it really starts with having the same goal and the aligned missions. But that is a huge part of building out capacity, and you can't do it in a silo.

Integrating Oncology with Primary Care

There's two things you mentioned: moving care upstream and then decentralization. A big part of that could be integration with primary care. There seems to me to be a lot of opportunity there. We're seeing this trend towards more and more care provided in the primary care space and a swinging in reimbursement to rewarding high quality primary care. Perhaps there's room for investment there and greater integration of cancer programs with primary care. Is that something that's on your radar?

Completely. If it wasn't on your radar before, if you look at the latest proposed rules and where CMS is going, clearly they're putting more into primary care and the emphasis on building up primary care. On the specialty side, we've talked about it similarly within ACCC and as a consultant, really thinking about the fact that you don't have to own primary care, but you need to make sure that those relationships are really tight and that coordination is there.

Almost every project I did would begin with data and doing the qualitative interviewing to get feedback. It was very physician and clinician focused with talking to your referring providers about the patterns of where care is going and why. Usually there are some relationships that are working okay, but for certain tumor sites, there's just something that is bottlenecking. You can work through why they are referring out or why this is not working with the local hospital in town. Doing it from a disease site specific perspective can be really eye-opening to resolving the issues that are there.

Again, going back to the partnership and I think with cancer centers, sometimes they have the integrated hospital system that has primary care as one avenue and one referral feeder. But I think you have to look at primary care more broadly. There is this growth in primary care through private equity and through non-traditional models, but it still means that coordination has to be there.

A Disease-Site Specific Approach to Care

Megan, you made a great point about the disease site specific approach. That's what patient centricity really is about. That patient likely is going to have that one cancer that is their adulthood defining illness. So much about the way practices are anchored is by specialty—surgical oncology, radiation oncology, medical oncology. And that's all great, but at the same time, we want to have streams of work and groups that are together around the patient's condition. Do you find that that is an underappreciated switch that organizations can make to level up the care quality they provide?

I think one of probably the biggest areas of emphasis where we were talking about that now within ACCC comes down to the data and the understanding of your cancer market and your cancer program—what you're getting, what you're catching, and what is going out. In a lot of cases, the things that are going out are patients with means driving or flying to a location sometimes hours away.

Our mission is really about the equitable access to high quality cancer care, to leading cancer care that stays on the cusp of innovation and scientific discovery. If you want to keep that care closer to home, I do think you have to look at it through that disease site lens. The hospital EMRs and the Cerners and the Epics of the world, those don't just sit right on top of the cancer operations and work like a multidisciplinary cancer team works. So there is so much of that digesting of the growth that happened from years and years of health systems growing and I think tailoring our technology solutions to work better for cancer programs.

Once you start really looking at the data that way, it becomes a lot more in line with the multidisciplinary care team approach. In the community space that I worked in as a consultant, sometimes there's a portion of cancer that's going out—head and neck cancer, for example—and there's no one locally that's taking care of that. Maybe that makes sense. But a lot of times you see GI, lung... those patients, the volume's pretty high and there's not the capacity set up within the community today to care for that or to keep that care close to home. Tackling through the bottlenecks and the barriers to things like that can really resolve a good amount of patient care challenges if you just do it on a tailored one-by-one approach.

Optimizing Clinical Roles and Top-of-License Practice

I've actually done both where you're in multidisciplinary clinics for some of these topics, like breast and thoracic or prostate cancers, and there's obviously pluses and minuses to them for sure. Going back to what you mentioned about capacity and tying it back to the APPs and navigation and nurses, I wanted to talk a little bit about where you see the role of nurses and APPs in expanding capacity and providing access.

I think at the most basic level it's around the top of license work. I know it's an overused term, but it really is very inconsistent with how you see APPs and nurses being used. I have seen APPs working as scribes in some communities. I'm not kidding you. They don't last very long. Having the strengthening of your individual multidisciplinary care team roles and then expanding their role scope where possible can really help to elevate.

Increasingly, looking at the cancer care team nurse not as the inpatient nursing standard or a remnant of the inpatient model, but having the roles tailored to the outpatient space or the inpatient space or the ability to flex. We see that a lot too with nursing flexibility; it's a satisfier for individuals who want to change or want to adapt.

I mentioned it earlier, but I do think it's really important to look at the roles of some of those clinical team members about how they can help to expand care upstream. That's the thing that is upon us, but we haven't really figured out how to do it well with moving the shift from what is very much still a procedural based hospital business model. We need to build out more preventative and screening based services. Sometimes you can see the role of a nurse navigator in a lung nodule clinic or another type of multidisciplinary pop-up model. It can be incredibly helpful. Diagnostic clinics is something we talk about a lot. It's kind of a remnant of the COVID years, but has been really effective for just getting patients in quickly under usually an APP led diagnostic clinic as a rapid access point.

That's a timely comment at least locally here for me in the program that I lead because just the start of this month we launched a diagnostic clinic for cancer care. Totally new. I have to report back in a month or two how that's going, but it's been a good start.

Technology and AI as Workforce Multipliers

We've talked about a lot as it relates to the specific people and the specific roles. Another element to workforce is technology as a workforce multiplier. And of course now you can't go two minutes probably in a day without somebody talking about AI. There is so much noise around AI from all these different perspectives. But really from your vantage point, Meagan, what do you think is the most practical way technology can relieve, not add to, the daily burdens of oncology teams?

Well, Anthony, I think you said it spot on. The motto that we have within ACCC is technology as a workforce multiplier. With a membership base of 50,000 different individuals and 1,700 different organizations, there is a lot of variety. We have to make sure that we're meeting organizations and care teams where they're at. The reality is that means some of them are on the sophisticated, very mature side of this AI spectrum, and then there's a lot of the hesitant, wait-and-see groups that have not really even stepped into that yet.

There's a tremendous amount of noise. I think something we hear a lot is helping to cut through that noise. I was amazed going to ASCO for my first time two years ago just as I had accepted this position. There were so many different AI companies there and there's just this innovation that's happening all over. In one lens you could say it's great, but I also think there's a lot of just innovation and people innovating to innovate. At ACCC, we're increasingly having some provocative conversations around needing to help cut through the noise.

There's a lot of garbage in, garbage out platforms that are not agnostic to the type of technology or that have a substantial startup cost. It's almost causing confusion for some of the smaller or less resourced places because it can block out a lot of the good options that are out there. We're starting to push out more tools. We have our National Oncology Conference next month, and there's a good number of AI case studies on the programming list, but we're still kind of showing examples of what good looks like and showing different models that are safe and in practice.

Now, a lot of those are not clinical point of care AI tools, but they're still helping to relieve workforce burden. You think about the ambient scribes and other things that we've had some members adopt with success. It usually takes showcasing that success story and even being able to talk through with the program how they got through their legal and compliance groups within their health system. We have to make sure they know it's a multiplier and not a replacement.

Managing Denials and Administrative Burden

I'd be curious to know regarding your personal story also—and something we've talked a lot about on our podcast with this whole battle of the bots. Obviously you're talking about tools around reducing physician burnout and improving efficiency. But I'm also curious, is ACCC investing in any tools around working through the denials process and claims management? My center, for example, is always worried about our margins, particularly around stuff with drugs and the utilization management around that and the denials.

I think a number of the tools that we're showcasing today are used as that extender or that multiplier, but they don't take the human element out of it entirely. That's where you can see the use of a tool to help with the prior authorization forms. They're all different for the different insurers, and the estimates are crazy—at least an hour a day per physician spent on those things. You can use some of the AI technology safely today, but it doesn't take out the human element of still having to do the manual review at a higher level or for certain cases that get flagged.

I think it reduces the burden of note taking and all that after-hours work that is really falling upon clinicians today in a way like never before. It can reduce that burden, but it doesn't take the human out entirely. There is a lot of eagerness and people are looking at this with open eyes, but also really approaching it with caution. Sometimes maybe even a little bit too much caution in some of our members that have not waded into this space at all. I certainly as a consultant saw a lot of legal counsels that were very strict. You could see something that was related to data sharing or related to the use of AI and it would just stop dead in its tracks. We do have to get over those barriers and learn how to adopt tools safely.

We also haven't said it explicitly, but I know you all have talked about just the bias that we're concerned about in some of the tools that are built on a population that doesn't represent the population that you're caring for.

The Challenge of Interoperability

You could probably see how your point resonated with Amar and myself by our facial reactions here. The point about hyper strict compliance really basically blocking what are potentially big time innovations to benefit patients and also providers in their work. I wanted to mention one specific word in all this gold rush: interoperability. The ability to have different EMRs talk so that we can see patients provide integrated care across systems. I'm hopeful that perhaps combined with regulations out of the government regarding API and communications between systems that we can finally get there. What do you think?

I think we're early on in this journey. I was at an NCCN AI summit last week and was one of the moderators of the breakout groups. There's a lot of proposals and requests about what needs to happen in the regulatory and legislative environment to help govern and ground all this new technology. But I don't think we're there yet with even the best practice standards.

If something is being rolled out there and it's not interoperable or it creates more of a silo of fragmentation within cancer care, to me, that's a solution that's problematic. We're still digesting and working through a lot of that with the EMRs and the EHRs that were thrust upon our cancer centers. Sometimes I say I bring the gloom and the doom from years of consulting, but the reality is we don't even have basic BI—business intelligence—in some of our cancer organizations. We have to start there, and then we can get to AI. But there is a tremendous amount of learning about the challenges when something is not easily layered on or not interoperable. It creates a real patchwork system that creates more fragmentation like we see today.

Oncology Care Models and Service Line Structure

I wanted to go back to the name change. You guys have changed from community, but historically, you were very focused on community cancer care, and I'm sure the vast majority of your membership is community cancer. Specifically, there's no one size fits all approach. Could you talk a little bit about oncology care models tailored to different provider settings and how does an oncology service line be optimized?

ACCC's membership of our 1,700 different organizations roughly breaks out into a third, a third, and a third. About a third are independent community practices, independent hospitals. That's where we overlap with COA, the Community Oncology Alliance. We don't work in a silo with anything, especially our advocacy voice; we're looking to align with others to have a more powerful voice where we can. But the rest of the balance of our membership, about a third of it is academic health systems and academic medical institutions. A lot of the NCI members are members of our organization. The remaining third is kind of a hodgepodge of all different types of community health systems, from large regional to sole community hospitals.

When we talk about oncology service line structures, it's more than just the organizational model. I go back to the fact that there's been such growth and diversification of networks and of hospital systems, but in many cases for years you saw them acting as a holding company and not really integrating across their different parts. When you have more ambulatory based specialties and a multidisciplinary specialty like cancer care, often you can see cases where something was set up but it wasn't truly connecting and coordinating the different providers at the operational level to make it easiest for the patient.

I always look at my rad oncs and I'm like, radiation oncology has actually done this better in some ways with developing the standardization of care in an appropriate way. But we're really looking at different models that are often spanning both academic and community settings within one health system. Not having the one size fits all but having different workflows and different means to funnel patients to the hub that provides the quaternary and tertiary care when appropriate, but mostly keeping it local in the community where you can.

At the organizational level, understanding how decision rights flow and how the leadership is structured becomes really important as you think about things like increasing clinical trials in the community and how research happens and flows through an institution across its different care sites. It goes back to having that brand promise so your patient, regardless of the door they enter, the physician that they see, and the location that they're at, has opportunity to still get to the same best practice care.

The Future of Telehealth in Oncology

You mentioned the pandemic earlier and obviously during that period telehealth was so essential. If you look at the data, patient encounters occurring as telehealth seem to be declining in most pockets of the country. One potential thing that I think is an opportunity gets back to the theme around connecting better with primary care, specifically eConsults, where primary care doctors can ask a specialist a question about a specific cancer scenario without even formally seeing the patient in person or by telehealth visit. Are you seeing anything that you think is particularly promising in the vein of telehealth?

I think the two big things that come to mind for telehealth... well, I think in general we have seen it be really effective especially for the Medicare patient population. If you can save that one visit from them going downtown or try to keep the follow-up care done over virtual, that helps. It's not all care that's going to be appropriate for virtual, but certainly a portion. Going back to the APPs and leveraging their scope of clinical practice as much as possible, it does become a good way to help decant some of the volumes that might be bogging down a physician. Filling up your APP more with follow-up visits or the eConsults is something that's appropriate to be done over telehealth.

The other use case is for the second opinion clinic and for that specialty consult so that you can have that extension to the academic subspecialist that sees patients just like you over and over again. From a patient lens, if done right, it can feel like you have that member of your care team virtually connected. We've seen very successful models of that.

Designing for the Future: Patient Centricity

It's funny you mentioned that. This is not a promotion for this product, but I know I use something called the MedNet, where I get to hear from other radiation oncologists and medical oncologists across the country on some of these topics. I found that very helpful. As we're getting toward the end of our episode, I kind of wanted to think toward the future. If you could design an oncology care form from scratch to meet the needs of tomorrow's patient population, what would be the first structural change you'd make?

Man, that's a hard question. Well, I think it all goes back to having the patient at the center. Patient centricity. I feel like we've kind of gotten over those terms in ways because in a lot of cases they held this promise that didn't come to fruition. I had this favorite slide I used as a consultant and put it in front of almost every different C-suite team I would work with. It shows the patient journey from previvorship and early detection all the way to end of life, palliative, and survivorship.

Traditionally, if you think about the hospital business model and the way that we view the patient lens, too often we're still measuring it based on when that treatment journey starts—when the butt goes in the infusion chair. Honestly, a lot of times the KPIs we're measuring are at that throughput and that focus on procedural efficiency. We have to really break from the traditional fee-for-service model.

We need to get to a better place where we're innovating and trying out different things for the payment of cancer care. The OCM days were really great in that way because there were so many different learning exercises to understand how to measure the total cost of care for an episode or for a bundle and how to build out data capabilities and put in care coordinator resources whether or not they were directly reimbursed. I think we've had a lull in value-based care, but we really do need to reinvent and think about that in a completely different way because reimbursement isn't going up and these challenges are going to be here to stay.

I think that's honestly a really good opportunity for ACCC because the KPIs for radiation oncology or medical oncology aren't really that useful or that helpful or that accurate in really promoting true quality or value-based care.

Financial Sustainability and Value-Based Care

I agree. You said a couple of things, Meagan, that I think are really important. You were talking about OCM models and total cost of care. There's a real opportunity and it's a shame that more organizations have not developed their cost accounting capabilities to really understand what is the actual cost of providing this service. The other piece of that—and I never hear people talk about this anymore—is IPUs or Integrated Practice Units. This gets back to the multidisciplinarity and the team care approach around that patient centricity. A lot of times organizations don't even understand the way work is done to solve problems for clients. In our case, it's for patients.

I think some of the things I've been saying for years to clients going in and reorganizing or setting up the system-wide oncology service line... financially you have to be measuring these things. If you dig in and look financially, are you measuring it at a system-wide level? Sometimes no, not at all. Or sometimes the ambulatory side is still a loser. It's really strategizing in ways where you have to think about your drug purchasing plan that isn't reliant on 340B as much, because I've seen 340B do great things, but 340B is under the gun and it's not going to be what it was historically.

Same thing with even the ambulatory side of the practice. A lot of times it's measured and set up to be a loss leader, but you have to figure out how to separate these things so it's not just reliant on your classic traditional hospital business model, because it's not going to be sustainable. I think you can do these things in measured steps to get there in a way that feels manageable, but it does take forward-thinking leadership that is willing to look at value, understand total cost of care, and eventually go at risk.

Closing Remarks

I want to thank you for coming on and once again highlighting the ACCC's 50th anniversary this past year. I know both our organizations are part of ACCC and I've been attending the meetings and I find it such great value added. So I want to thank you for coming and sharing all your insights with our listeners.

Well, thank you all for having me. This is great.