Looking Ahead to New Opportunities and Challenges in 2021

Dawn Holcombe, MBA, FACMPE, ACHE
Editor-in-Chief
President, DGH Consulting, South Windsor, CT

No one can say that 2020 has been an ordinary year, although for most of us, it started out in a fairly normal manner. For me, it meant celebrating the New Year, writing, and enjoying some occasional snow. My speaking engagements and travel began ramping up in January, February, and early March, which allowed me to meet with colleagues and clients at practices, hospitals, and conferences. Then, the COVID-19 pandemic hit, and the bottom dropped out of all our worlds.

Healthcare was in the thick of this new crisis, as all roads led to medical facilities—especially hospitals. Suddenly, our healthcare teams had to step up. While much of the country sheltered at home, binge watching their favorite shows and shopping online, medical professionals had no choice but to soldier on, protecting themselves the best they could when they left for work each day, and taking care of their families when they arrived back home. There are not enough words to praise and thank every single member of the healthcare community for their grit, guts, and “can do” attitude in the face of this unprecedented crisis.

During the pandemic, innovation became the hallmark of healthcare. Many, if not most, medical practices remained open, making modifications as needed. They sanitized their facilities and rescheduled appointments to offer the best protection possible for staff and patients. Some practices staggered their shifts, requiring a full medical team to stay out of the office each day. This strategy ensured that if an outbreak of the virus occurred, other team members would still be able to care for patients at an alternate location the following day.

Telemedicine advanced overnight after years of inactivity, and innovations such as drive-up blood draws, shot clinics, and testing became commonplace. We learned how to use tools and apps so that patients could check-in from homes, parking lots, and waiting rooms, and we became experts at screening patients, managing COVID-19 tests, and communicating with health departments and testing sites.

As we approach the end of the year, we have seen an increase in patient volumes at practices and medical centers, and workplaces have achieved a tentative “new normal.” Although we will never revert to the way things were at the beginning of 2020, we can pick ourselves up and reboot. At some point, we will adjust to living with the virus. So, what might lie ahead in 2021?

Opportunities for Better Communication and Collaboration

Shaking hands and hugging have been replaced by smiles, nods, and socializing with some space between us. However, I hold out hope that we will be able to meet and network at conferences in person in 2021. So much more gets accomplished in person—imaginations get fired up, ideas ping back and forth faster, and partnerships are solidified. I think that if we can safely shop and hand-pick our fruits and vegetables, we should be able to get back to responsible, in-person meetings.

Pharma and provider interactions may never be the same. In-person meetings and functions were already shrinking. The pandemic closed doors to non-patients in most offices, forcing dramatic changes for pharma communications with providers. We are learning how to consolidate information and deliver it on new platforms. Zoom meetings and webinars have become ubiquitous but raise challenges for important casual conversations and communications.

Fortunately, state societies and professional associations have risen in importance in terms of communication and advocacy across the oncology landscape. Joining voices to share concerns about pharmacy benefit managers, coverage, financial toxicity issues, and our patients’ access to needed care will continue no matter how our lives have changed. No virus can block our common commitment to use our “might for right” and point out how others can abuse their might to the detriment of patients with cancer. We have learned the importance of connecting regularly (even if this cannot be done in person), to share information on emerging issues, and to develop common reactions as an informed national body, not isolated silos.

Employers and managed care have begun to recognize the value of collaborating with the cancer community and the potential for increased quality and outcomes that may result from these interactions. As reports of delays in care and screenings surface, quantifying the financial and health implications of undetected or late detection of cancers, employers and managed care have started to worry about downstream premium and cost of care implications. Suddenly, the reasons for, and the value of, “routine” mammograms and cancer screenings have taken on heightened importance. Delays in biopsies and colonoscopies have given rise to alternative discussions, including utility of noninvasive screenings and care.

We have learned to pivot on a dime and leverage flexibility when it makes sense. Site of care is now an even hotter topic for patients concerned about exposure and for hospital systems limiting services and conserving resources. This has led to a broader discussion regarding appropriate sites of care for cancer, moving way beyond the already heavily watched higher costs for different sites of care. In Connecticut, this has opened the door for a frank conversation with employers and health plans about appropriate value paths for patients with cancer, and the folly of one-stop shopping under a center of excellence model compared with a more widely dispersed value model, which parses care across the most appropriate sites of care (including private practice centers).

We have learned how to adapt and integrate other data systems and services into our routines, and sometimes, even in concert with our electronic health record systems. The new “value” conversation driving much of healthcare demands data tracking and analytics that are far beyond the reach of any electronic health record system. The pandemic may have given us the boost we needed to execute workarounds and think outside of the box in terms of gathering information beyond the confines of legacy electronic health records.

Addressing Challenges in the Delivery of Care

The pandemic-related rise in the use of orals has become a double-edged sword for patients, providers, and managed care. Oral oncolytics may have reduced traffic in infusion centers, but the high rates of patient noncompliance and adherence for oral drugs—even those used to treat cancer—may lead to high expenditures on unused drugs or adverse effects on cancer treatment progression and other costs of unmanaged toxicities and side effects.

One of the most controversial topics that arose around cancer care in 2020 was the question of chemotherapy delivered in the home. The complications of safe delivery of chemotherapy have given rise to complex cancer centers with multiple safety checks and support mechanisms to protect patients, staff, and the efficacy of the drugs themselves. Some cancer centers made limited conversions to home infusions, whereas most of the community raised concerns and issues to avoid any expectations that post-pandemic continuation of home chemotherapy infusions would be a natural evolution.

The integration of telemedicine has proven to be a complex, but viable, addition to the tools we have available to care for patients with cancer. There are new opportunities for enhanced family consultations, tightly managed interim patient check-ins, and medical conversations via telehealth visits. However, oncologists know that they still need to see their patients in person to detect less obvious cues to looming issues. It is likely that there will be a continued acceptance of technology to support cancer care, and the hurdle of fair compensation still looms, but the kickstarting of this option by the pandemic was a silver lining in the midst of the storm.

As we look to 2021, there will be more opportunities than may meet the eye, and things are bound to go more smoothly than they did in 2020. So, join me in lifting a glass, watching the ball drop in Times Square, and saying “Out with the old, in with the new!”

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