Barbara L. McAneny, MD: I'm Barbara McAneny. I'm a medical oncologist and the CEO of New Mexico Oncology Hematology Consultants in Albuquerque and Gallup, New Mexico. I am a COA board member, and I am a former president of the American Medical Association.
OBR: What makes the COA 2024 Community Oncology Conference significant for oncologists?
Dr. McAneny: COA is the spokesperson for oncologists who wish to remain independent. This is the organization that looks at all of the issues that confront community oncology, helps us remain independent, helps us fight the battles that we need to fight as an organization, [battles] that are impossible to fight as an individual practice. When one oncology practice remains independent and strong, it benefits us all.
OBR: What do you feel is the most important discussion going on at the conference?
Dr. McAneny: I think it is the consolidation of the market. Many of us are struggling under the Change Healthcare/Optum breach. I think that Optum purchasing Change Healthcare set the country up for this. When you get to be that big and that much of healthcare is consolidated into one entity, when that entity has something catastrophic happen to it, it can bring down a huge amount of the healthcare system. I think the most important conversation at COA right now is how do we protect ourselves against institutions like Optum/Change Healthcare getting so big that they have the ability to cause serious harm to the delivery of healthcare across the country.
OBR: Are there antitrust concerns, in your opinion?
Dr. McAneny: I think it is a serious antitrust issue. And the Federal Trade Commission (FTC) actually tried to block this merger because it is a vertical integration. And vertical integration is now increasingly recognized as an antitrust problem. And this is a perfect example of why, with the Change Healthcare breach. If we were allowed to have choices, we would be able to pivot from one area that got harmed immediately to another area without having the damage that we're seeing from Change Healthcare.
We are watching practices being put under by this lack of funding coming through. No bills are getting paid, and then Optum scoops in and employs those doctors. Optum is now the largest employer of physicians in the country. I think that is a serious problem that the FTC or Department of Justice needs to look into because I think that threatens a lot of healthcare. We're not making widgets here. We're talking about people's lives, and we cannot gamble it all on one company that gets so big and so profitable that they control everything. Where's Teddy Roosevelt when we need him?
OBR: Your institution opted out of the EOM after testing it. What value-based care models do you think should be explored next?
Dr. McAneny: I'm personally very disappointed in the way that the Centers for Medicare & Medicaid Innovation is moving forward. I believe they should be testing a thousand different ideas and figuring out which one works and then expanding on the ones that work instead of trying to create one out of whole cloth out of Baltimore, which is what EOM is.
I also think that it's time for value-based care to stop being just value to the payers and start focusing on being value to a patient. What a concept? We have been working with local payers who understand that community oncology is the low-cost but highly effective and high-quality place for patients to get care. I think the next opportunity is our local payers. We also are interested in working directly with employers because employers want the best for their employees. They want to fix the cancer and get people back to a normal life, which includes going back to work. I think there's a lot of opportunity to look at how we can create value with employer partners. I think that will be the future of value-based care.
OBR: How valuable is non-medical support for clinical outcomes and patient relationships at your institution?
Dr. McAneny: In my practice, we use the triage pathways that I developed during the COME HOME program, and that provides computerized decision support to the nurses. When any patient calls in with any version of "I'm sick," that patient gets a callback within an hour. If [that patient] needs to be seen that day, they are seen that day. This is what builds trust with patients. They need to know that we are there for them and that we will see them when they need to be seen, as opposed to when it's convenient for us to see them. And [they need to know] that we will get them to the site of service that can take care of their immediate problem. That is a huge quality metric for patients: that they know that they will be taken care of. That [care] keeps people out of the hospital. Cancer patients hate being in the hospital. And whenever they're in the hospital, when they leave the hospital, their quality of life is never quite as good as it was before.
For me, being able to respond to patients where they are and give them the services they need when they need them at our cancer center – where we can give them infusions and where we can get that high-resolution CT [scan] to see if they had a pulmonary embolism at a quarter of the price of going to the emergency department and a whole lot faster – to me that is the very definition of quality of care.
OBR: Do you feel this strategy can be incorporated at other institutions?
Dr. McAneny: I think it can be. And during COME HOME, we showed that it was. It requires a little bit of restructure in the way the practice works. The triage pathways I offer out to anyone who wants them. The requirement is that you have time in the schedule. This is what we use our advanced practice clinicians to do: to have time slots in their schedule so that when we need to see someone who needs to be added on that day, there's really a place for them. It's not an inconvenience to people. It's part of what they expect to do every day.
So patients can get in and be seen and taken care of, and the whole practice just works as a big machine to do that. I think that's easily replicable. Furthermore, I think it can go past oncology. Now my practice also has urologists and rheumatologists and pulmonary docs and surgeons. And we can use that same model for those patients as well. I think any chronic disease that has acute exacerbations we can manage better with a COME HOME–type model.
This transcript has been lightly edited for clarity.
