Outcomes-Based Pricing & EHR Interoperability | Tyler Sandahl, PharmD
Teh Push for Value and Seamless data Sharing in CAR T and Bispecific Therapy
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The burgeoning field of cellular therapies, including CAR T-cell therapy and bispecific antibodies, offers groundbreaking treatment options for cancer patients. Though, the high cost of these therapies, coupled with challenges in data sharing between academic medical centers and community settings, are meaningful hurdles to broader access and optimal patient care. Experts are increasingly advocating for outcomes-based reimbursement models and improved interoperability of electronic health records (EHRs) to address these issues.
The Need for Outcomes-Based Reimbursement in Cancer Care
The escalating cost of cancer therapies is a major concern, and simply securing full reimbursement for providers isn’t enough, according to Sandahl, a leading voice in the field. A shift towards outcomes-based pricing and reimbursement is crucial.
“We need to ask what is giving patients the best bang for their buck,” Sandahl emphasized. “It’s great to talk about reimbursement for us, and if we’re getting reimbursed fully, to see some of those savings passed on to the patients.”
Currently, ample costs are incurred for therapies that may only offer incremental benefits - for example, extending patient life by a matter of weeks compared to existing treatments. An outcomes-based model would prioritize therapies demonstrating significant value, ensuring resources are allocated effectively and patients receive the most impactful care. This approach necessitates rigorous cost-benefit analyses and a focus on therapies that demonstrably improve patient outcomes.
Bridging the Data Gap: The Importance of EHR Interoperability
Effective collaboration between academic centers, which frequently enough pioneer these advanced therapies, and community oncology practices, where many patients receive ongoing care, is paramount. However, a major obstacle to this collaboration is the lack of seamless data sharing.
Sandahl highlights the ideal scenario: “Everyone on the same EHR so you can log in and see records from outside.” While systems like Epic’s Care Everywhere offer some connectivity, they aren’t always real-time. Delays in updates and the need for manual record sharing create significant challenges.
The difficulties are amplified when academic centers collaborate with community practices utilizing different EHR systems. This often leads to reliance on patient self-reporting, a method that is both burdensome for patients and prone to inaccuracies. It also creates administrative overhead for institutions attempting to manually share information.
“You don’t want to put it on the patient to be constantly updating you,” Sandahl stated. “It also becomes a huge administrative burden for institutions to try and share. There needs to be some sort of automated mechanism for sharing those updates so you can easily check in on your patients.”
Challenges in Patient Follow-Up and the need for automated Systems
the lack of real-time data access impacts the ability of providers to consistently monitor patients undergoing CAR T and bispecific therapies. Sandahl described the frustration of having reminder systems alert them to follow-up with patients when no recent data is available.
“Sometimes it’s challenging when my little reminder list pops up alerting me it is indeed time to check on someone, and I can’t see any records, and I haven’t seen anything for 6 months,” she explained. ”I just say, ‘We will check on them again in 2 months and see where they’re at or if any issues have popped up.'”
This situation underscores the need for automated data sharing mechanisms that allow for continuous monitoring of patients, regardless of where they receive care. Improved EHR interoperability is not merely a technological issue; it’s a critical component of ensuring patient safety and maximizing the effectiveness of these potentially life-saving therapies. Ultimately, a more connected healthcare ecosystem will enhance patient access, continuity of care, and clinical outcomes in the rapidly evolving landscape of CAR T and bispecific therapies.