2024 Rewind: Most Memorable Quotes & Insights

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Ashutosh Sheth: Hi everyone, this is Ashutosh Sheth with HMP Market Access Insights, the leader in the know-how and know-why in oncology. We would like to welcome you to our Q4 2024 podcast from our Insights to Access series. Throughout the year, the team works hard to stay abreast of key developments and trending topics in the oncology space.

We do this through a host of methods, including a continuous dialogue with peer provider advisors, key opinion leaders, and survey respondents. We use these perspectives to strengthen our own research and deliver actual insights to you, our subscribers. Today, you'll be hearing from our team members about key quotes and insights from conversations they have had this year.

As a note, this podcast is just one piece of the comprehensive 2024 package of oncology market access research assets that our client subscribers receive to deeply understand their customers and make better business decisions. For more information, please visit our website at www.marketaccessinsights.com. Now, I'll hand it off to Cindy to share her quotes and insights on oncology pathways. 

Cindy Chen: "It's just not worth fighting those battles." In 2024, we had plenty of interesting discussions with providers and payers. However, what resonated with me were some of the learnings from our oncology pathway research.

As a part of our research, we look to understand oncologists’ perceptions and experiences with both provider-developed pathways and payer-developed pathways. Now, here is where we heard multiple oncologists tell us “it's just not worth fighting those battles.” When it comes to payer recommendations—be it policy or pathways—its first worth noting that the majority of oncologists do not generally even interact with these tools unless the oncologists’ preference conflicts with what the payers want.

When these preferences clash, the oncologist must decide whether to justify his preference, which often requires additional paperwork and/or peer-to-peer discussions, or to switch and comply with the payer-recommended treatment. What we hear from the oncologist is that if the payer preference is clinically consistent with guidelines—meaning the National Comprehensive Cancer Network (NCCN) guidelines—and the oncologist does not see significant clinical differences between the treatments, then the oncologist will switch to that payer-preferred treatment. In these cases, for the oncologist, “it's just not worth fighting those battles.” However, if the oncologist believes one treatment is clinically more efficacious or more tolerable for a patient, then it is a different story.

We recently heard from one oncologist who started his patient on a treatment using a manufacturer assistance program while going through a payer-mandated process for over 40 days until he prevailed. For him, it was worth fighting that battle because of the better side effect management for his patient, which sets that treatment apart, irrespective of what the payer pathway was recommending.

So what resonates with me? As oncologists interact with multiple recommendations and utilization management strategies, if the oncologist perceives significant clinical differentiation, he will step up and fight the battle. 

Sheth: Thanks, Cindy, for sharing your insights on oncology pathways. I'll now pass it on to Dan, who will be sharing quotes and insights on pathways workflow.

Daniel Buchenberger: In my research on pathways, a big component I've been emphasizing is on workflow design and assessing when in the physician decision-making process are they encountering a pathway. This is really important because we're trying to understand how influential a pathway is on a physician's treatment decision.

So whether that is prospective—before they're writing the script—or retrospective—after, when they've had a challenge—it is a really important variable to understand. So my quote that I love this year that talks about some of the interesting dynamics around this issue comes from Pharma Day, part of the Clinical Pathways Congress that happened this fall. The quote is a 2-part quote. There were 2 panels that happened back-to-back. The first one was from pathway developers and the second one came from pathway users, or physician practices that are using it in talking about this issue of accessibility. 

The first quote comes from Craig Hunter of Carelon. He went on to say: "And so when a provider comes into our portal, they are going to be presented with all the options based on the patient characteristics they are putting in.” Clearly communicating a belief that providers are accessing their prior authorization (PA) portal and seeing the pathway in that.

In the second session, Barry Russo from the Center of Cancer and Blood Disorders, speaking to his experience said: "Yeah, there's not a physician in our practice that knows what a portal is. If I say portal, they would think it's our patient portal. They've never accessed anything on the payer side."

The conversation continued to discuss the emphasis on PA teams and precertification teams using that payer portal. I really love the juxtaposition of these 2 quotes because in all of our discussions this year in trying to assess the impact of payer pathways, in this discussion around when are you accessing them, we're discovering here that payers have set up a system or developed a system that they believe providers are accessing. That is where their ability to influence a decision is coming from. And yet we're seeing, from the physician side, that they're not even aware that the portal exists, let alone accessing that portal. It really just shows the amount of work we have to do on the pathways front in improving these systems and ensuring that patients are getting the best coordinated care between these 2 stakeholders, where so many decisions about their care are made. 

Sheth: Thanks, Dan, for sharing those insights on pathways workflow design. I'll now pass it on to Lee, who will be sharing quotes and insights on physician-payer interactions in integrated delivery network (IDN) partnerships. 

Lee Blansett: "I don't remember having had a call with a payer." That was an unexpected perspective that was shared with us during an interview with a physician during the pathway research this year. The physician works in a medical group that has a set of pathways which are followed pretty religiously by the oncologists there. In the process of following the pathways, the physicians are largely directed to the higher levels of NCCN evidence type regimens, and, generally speaking, are very likely to be approved without any sort of a denial or firm PA.

At the end of the day, by following the pathways in this group, which are based upon level 1 and level 2 evidence from NCCN, the physicians find that they're able to get through PA with very low pushback from the payers. 

"A few years ago, I only recognized 2 types of providers: employees and competitors." That's a quote from the CEO of a small IDN in the Pacific Northwest, who was talking about partnerships at a conference this year. This is a really important quote because I think it nakedly illuminates the gap between where we are and where we need to go in terms of health system organization. Hospital executives that traditionally really only have been comfortable if they actually directly controlled or employed anyone—from a janitor to a neurosurgeon—believing they needed that level of control. 

Doctors, on the other hand, by and large, of course, did not want to be controlled that way. Although there has been an awful lot of change in the last 30 to 40 years—and now, in fact, most oncologists are employed by IDNs—I think there is still a large gulf there between the community and the hospital system. This is a gulf that needs to be filled if we're going to actually be able to deliver high-quality oncology care either in IDNs or in a community setting, particularly at reasonable prices. So this is, I think, a clear illustration of why integration has stalled to the extent it has been.

Sheth: Thanks, Lee, for sharing those insights on physician-payer interactions in IDN partnerships. I'll now pass this along to Emma, who will be sharing a quote on physicians' attitude towards cost when prescribing.

Emma Bijesse: Earlier this year, Cindy and I were interviewing oncologists from IDNs. We interviewed oncologists from a variety of health systems, including small community hospitals, academic medical centers, and large networks. We asked all of these oncologists how they think about costs when selecting treatments and got a variety of answers.

I'm going to read one answer that we received: "If I have a choice between 3 doses of immunotherapy prior to surgery or a year of immunotherapy after surgery with equivalent efficiency when I'm treating early-stage lung cancer, I'm going to treat with the less expensive option because it's equally effective and 75% less expensive, back of the envelope, because in the health system at large, ultimately somebody pays for it. So whether or not the patient actually sees it, I think it's probably prudent just to not use a resource if you don't have to."

I really like this quote because I thought it demonstrated that physicians need to think of so many things when considering costs. Are they thinking about health system costs or financials? Are they thinking about patient costs? Or even the health care industry more broadly? Even without the best data, our interviews indicated that physicians are considering costs and the impact that treatment decisions have on these costs. 

Sheth: Thank you, Emma, for sharing your insights on the role of cost in physician prescribing. And I'll pass this on to Chris, who will be wrapping up this episode by sharing quotes and insights on CAR T and bispecific antibody therapies. 

Chris Van Denburg: Hey there, this is Chris. This year, I'd like to highlight not just one quote, but essentially hundreds of quotes all about the same thing, and a reminder to dig in.

What I mean is that while researching information for our 2024 special topic report on CAR T and bispecific antibody therapies, there were countless headlines and mentions of adverse events (AEs) associated with these therapies—and rightfully so. The rates of any-grade cytokine release syndrome (CRS) or neurotoxicity, including immune effector cell–associated neurotoxicity syndrome (ICANS), are typically very high, even in the 90s.

But if you dig into the data, you'll see that this is not always the case. Even with CAR T therapies, the occurrence of grade 3 or above CRS or neurotoxicity can actually be extremely low. For bispecifics, it has been shown that some have only around 1% of patients developing grade 3 or above CRS or neurotoxicity over the entire course of therapy.

I'm not saying that practitioners shouldn't monitor diligently or pay close attention, but providers who are reluctant to try these therapies based on broad stroke comments about AE frequencies could serve themselves and their patients very well by really digging into the data and looking more closely.

They might just find certain products that they are comfortable using and, therefore, able to provide powerful therapies for their patients. I think this reminder applies to normal life as well. When facing challenges, difficult decisions, and even worries and fears, again, dig in. Dig into available information, into feelings, into ideas, into your hopes and dreams, and dig into understanding others. I know that this will help you walk your path of personal values. 

Changing gears a little, an actual quote that came up during the same project that stuck out for me is when a CEO of a provider group, during an interview, was talking about a patient perspective with respect to repeated provider outreach following bispecific antibody infusions.

In other words, following a bispecific antibody infusion—during a step-up or initial treatment dose—some provider groups have protocols to contact the patient multiple times per day as a mechanism to monitor for AEs, namely, again, CRS or neurotoxicity, including ICANs. The quote I heard from the CEO, from a patient perspective, again, was: "I appreciate you calling me, but don't call me anymore. I can't afford it." What he was talking about is that when offices bill for these proactive outbound follow-up monitoring calls, patients pay a copay for them. When there are a lot of calls, there are also a lot of copays. 

Thanks, everyone. Have a great 2025. 

Sheth: Thank you, Chris, for sharing your insights on CAR T and bispecific antibody therapies. And now to all our listeners, thank you for tuning into our final 2024 podcast from HMP Market Access Insights. As we roll into 2025, please be on the lookout for announcements, insight summaries, annual reports, and more podcasts. Additionally, we'll continue to keep a pulse on key developments and fine-tune our insights on the topics mentioned here and many more.

To learn more about our work, please visit us at www.marketaccessinsights.com. From all of us here at HMP Market Access Insights, we wish you a happy holidays and a wonderful new year. We look forward to connecting with you in 2025, and as always, we hope you got a great deal of value from these Insights to Access.