Oncology care in the U.S. is changing rapidly.
Both the oncology patient’s and his or her provider’s cancer care experience will be completely different a decade from now, driven, in large part, by the increased implementation of digital health technology both inside and outside of the treatment center.
Digital technologies that can monitor, collect and analyze patient data through the use of medical-grade wearables or facilitated patient reporting will expand the medical record, contribute to a more comprehensive understanding of the patient and inform the care plan with data-driven treatment solutions.
Personal health trackers and apps will allow for increased regimen compliance and ensure better outcomes. Telehealth platforms will continue to expand access to quality treatment modalities, allow providers to leverage and focus their resources as well as to provide patients with real-time opportunities for interaction with their caregivers throughout the treatment process.
Increased use of predictive analytics and innovations in artificial intelligence will contribute to new strategies to more effectively treat cancers and reduce costs of otherwise expensive treatments without otherwise affecting quality.
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The CMS Oncology Care Model, and similar models promulgated by commercial payers, requires practices to provide patient navigation, use data to drive continuous quality improvement and share with beneficiaries in the decision-making process. New digital health offerings are introduced in the market almost daily to help meet these goals.
Oncology practices are starting to tackle implementation challenges by deciding where to invest their care management dollars and determining which technologies will bring the best return on investment, both from a quality and cost perspective.
In the next few years, we expect to see the accelerated adoption of digital technologies in oncology as more technologies are approved; payers introduce new reimbursement models such as the new Medicare Virtual Check-Ins that became effective Jan. 1; and studies evaluate opportunities for enhanced outcomes, improved efficiencies and reduced costs.
Providers and other leaders in oncology gathered at a recent meeting of the Cancer Center Business Summit and the Association of Community Cancer Centers in Washington, D.C., agreed that the challenges facing increased adoption are both operational and regulatory in nature.
Operationally, the data that can be made available through digital technologies may simply be overwhelming to filter, process and apply.
Digital technologies will also lead to increased volume as patients increasing self-report. Providers will need to hire staff and develop processes to triage the technology-driven changes.
On the regulatory side, digital health business models need to be structured to comply with myriad state and federal requirements, including state licensure and medical practice standards that may complicate any practice across state lines, along with coverage requirements and privacy and security requirements. In many of these legal areas, federal requirements establish a baseline that is required for compliance. However, state laws can expand upon the federal requirements and may include unique provisions that will also need to be taken into account.
Furthermore, as regulators work to sort through how to pay for and regulate the new technologies, rules are often contradictory, leaving providers unsure of how best to pay for and or provide access to these technologies.
For example, remote patient monitoring may now be covered by Medicare; however, once a product is covered, it can no longer be given to patients as a compliant beneficiary incentive within the Centers for Medicare & Medicaid Services demonstration models, requiring early adopting providers to reassess how they use the technologies.
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Collaboration and consensus building among providers and payers will be required to address these challenges. One area to watch will be reimbursement requirements for telehealth. Medicare telemedicine requirements currently mandate that a patient/practitioner communication occurs via a real-time interactive audio and video telecommunication system. These rules can be easily satisfied by telehealth outreach models that support rural clinic locations.
However, they will effectively preclude the expansion of telehealth modalities to patients at their home, even as supportive technologies become more widespread.