Ethan Basch's guest appearances

Ethan Basch

Relentless Health Value™

ASCO Daily News

Mark Lewis

Lindsay Davis

Vinay Prasad

Stephen Liu

David Fajgenbaum

Lindsey Davis

Scott Gottlieb

Heather McArthur

Nina Shah

Oliver Sartor

Gary Lyman

Megan Kruse

Fumiko Chino

Gilberto Lopes

Larissa Korde

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Welcome to the ASCO Daily News podcast. I'm Lauren Davis. And joining me today is Dr. Ethan Basch. He holds several professional titles at the University of North Carolina at Chapel Hill, including Distinguished Professor of Oncology and Director of the Cancer Outcomes Research Program. Dr. Basch is a member of ASCO's board of directors and recently served as the program chair of the ASCO Quality Cancer Symposium. Dr. Basch, welcome to the podcast.  Thanks so much. Nice to be here.  We're glad you're here. So you've just returned from the conference. How was this year's event compared with previous years?  This year's event was a great success. Similar to prior years, the conference focused on quality of care delivery. But increasingly, we have seen a move towards research and practical presentations around value-based care and alternative payment models. I would say that what was particularly successful this year was the bringing together quality activities in the community with academic research that is being conducted by health services research.  Increasingly, we've been seeing that community-based quality initiatives are beginning to use more rigorous scientific methods and similarly that academic research is becoming more practical and community-based. And this conference really shows the marriage of the two at this moment in oncology.  That's great. So which presentations or abstracts did you find the most compelling or practice-changing?  There were so many terrific abstracts this year, we had a very difficult time choosing the oral abstracts for the meeting. And we had more than 500 submissions of scientific abstracts for the meeting. I thought I would go over three of the abstracts that I found particularly exciting and that I think reflected some of the overall themes of the meeting.  The first was from Kerin Adelson, who's a medical oncologist and a quality officer at Yale Cancer Center. And Yale is one of the participating sites in the Oncology Care Model, which is the Medicare Innovation Center's demonstration project for an alternative payment model in oncology. And they've been participating over the past several years implementing a number of value-based care initiatives to try and reduce costs and improve quality.  This has included broadening their care coordination and navigation services, providing an alternative pathway to the ER to an acute care center, providing access to providers 24/7 with access to the electronic health record, and several other patient-oriented initiatives.  And over time, they've looked at the impact of these initiatives on their total cost of care. And they've broken it down into different categories. And at the meeting this year, Dr. Adelson presented what's happened specifically to the cost of emergency room and hospital utilization, as well as pharmaceuticals.  And what they found at Yale is that as they progressively implemented these value-based programs, they also progressively decreased the amount of emergency room and hospital utilization quite substantially and significantly, yielding a decrease in cost. However, simultaneously, the cost of drugs increased as we all in oncology are acutely aware of. In fact, the cost of pharmaceuticals went up by about 9% per year. So while they very substantially drove down the costs of emergency room visits and hospitalization, they were barely able to keep up with the rising costs of pharmaceuticals.  The second abstract, I think, of particular interest also relates to the cost of drugs. This was a presentation by Bernardo Goulart from Scott Ramsey's group at Fred Hutch Cancer Research Center in Seattle. They are particularly interested in the relationships between the costs of drugs and adherence and other outcomes. Now, previously, there have been several studies published by investigators like Stacy Dusetzina at Vanderbilt showing that as the incremental out-of-pocket costs of drugs goes up that adherence with drugs goes down, i.e. the more that people have to pay out of pocket, the less they take their drugs. And drugs that this has been particularly shown for are oral tyrosine kinase ACE inhibitors. And this has been looked at in a number of different diseases. In this particular study, Dr. Goulart and colleagues looked at the relationship between higher patient out-of-pocket TKI costs and both adherence to drugs, but also overall survival. And consistent with prior studies, they found that greater out-of-pocket costs were again associated with lower adherence. But in this case, they added on the overall survival metric and found that in fact, higher out-of-pocket costs were associated with worse survival.  This is important information as we as a country think about how out-of-pocket costs are structured within benefits programs, that in fact, there is a vigorous debate in Washington currently around Medicare Part D and patient out-of-pocket obligations. And this study provides additional evidence that the greater burden our patients face in terms of their financial toxicity from their out-of-pocket costs, the worse their outcomes are going to be. The third abstract that I would like to highlight is by Erin Elizabeth Hahn from Kaiser Permanente Southern California. This study is on a slightly different tack. This is around implementation of distress screening and patient-reported outcomes in clinical practice. Now, many listeners may know that patient-reported outcomes is an area of particular interest to me, but also to many of us who are involved in value-based care because previously, implementation of patient-reported outcomes in clinical practice has been shown to drive down ER visits and hospitalization, to lengthen the amount of time people can tolerate chemotherapy to improve health-related quality of life and to improve overall survival.  But one of the challenges around distress screening and patient-reported reported outcomes has been implementation because it is simply difficult logistically to implement collection of information from patients about their symptoms and functioning during routine practice, which is already crowded with all sorts of things that we need to do.  So in this study they employed a pragmatic clinical trial design and did a randomized study of using cutting edge implementation science and quality improvement methods to roll out patient-reported outcomes in practice. And they did this in their very large practice. And what they found was that when they used QI principles and implementation science to roll out patient-reported outcomes and distress screening, they had very successful uptake. In fact, 94% of patients who were in the arm that used cutting edge implementation science and QI approaches completed their distress screening and patient-reported outcomes, which was significantly and substantially higher than the arm in control that did not use those approaches.  This suggests that for any health system or practice that wants to implement patient-reported outcomes or distress screening and be successful at it really should use our standard QI processes that iteratively work with providers and in this case with patients to make sure that there's understanding, training, uptake, and sustainability.  That's great. It sounds like great strides are really being made in value-based care. Were there any other takeaways that you saw as important during the conference?  Well, I think that overall across the conference, we saw a lot of enthusiasm around the kind of value-based care initiatives that are reflected by these three abstracts. There's a lot of activity across the country, and also, I should note in Canada because there's a very substantial Canadian representation, to try to build in some of these value-based care approaches and figure out how best to implement them and to try to understand better their impact on costs and utilization.  That's great. Again, today, my guest has been Dr. Ethan Basch. Thanks so much for joining us again on our podcast.  Thanks so much. Pleasure to be here.  And to our listeners, thank you for tuning into the ASCO Daily News podcast. You can find all of our podcasts on podcast.asco.org. If you're enjoying the content, we encourage you to rate and review us on Apple podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Welcome to the ASCO Daily News podcast. I'm Lauren Davis. And joining me today is Dr. Ethan Basch. He holds several professional titles at the University of North Carolina at Chapel Hill, including Distinguished Professor of Oncology and Director of the Cancer Outcomes Research Program. Dr. Basch is a member of ASCO's board of directors and recently served as the program chair of the ASCO Quality Cancer Symposium. Dr. Basch, welcome to the podcast. Thanks so much. Nice to be here. We're glad you're here. So you've just returned from the conference. How was this year's event compared with previous years? This year's event was a great success. Similar to prior years, the conference focused on quality of care delivery. But increasingly, we have seen a move towards research and practical presentations around value-based care and alternative payment models. I would say that what was particularly successful this year was the bringing together quality activities in the community with academic research that is being conducted by health services research. Increasingly, we've been seeing that community-based quality initiatives are beginning to use more rigorous scientific methods and similarly that academic research is becoming more practical and community-based. And this conference really shows the marriage of the two at this moment in oncology. That's great. So which presentations or abstracts did you find the most compelling or practice-changing? There were so many terrific abstracts this year, we had a very difficult time choosing the oral abstracts for the meeting. And we had more than 500 submissions of scientific abstracts for the meeting. I thought I would go over three of the abstracts that I found particularly exciting and that I think reflected some of the overall themes of the meeting. The first was from Kerin Adelson, who's a medical oncologist and a quality officer at Yale Cancer Center. And Yale is one of the participating sites in the Oncology Care Model, which is the Medicare Innovation Center's demonstration project for an alternative payment model in oncology. And they've been participating over the past several years implementing a number of value-based care initiatives to try and reduce costs and improve quality. This has included broadening their care coordination and navigation services, providing an alternative pathway to the ER to an acute care center, providing access to providers 24/7 with access to the electronic health record, and several other patient-oriented initiatives. And over time, they've looked at the impact of these initiatives on their total cost of care. And they've broken it down into different categories. And at the meeting this year, Dr. Adelson presented what's happened specifically to the cost of emergency room and hospital utilization, as well as pharmaceuticals. And what they found at Yale is that as they progressively implemented these value-based programs, they also progressively decreased the amount of emergency room and hospital utilization quite substantially and significantly, yielding a decrease in cost. However, simultaneously, the cost of drugs increased as we all in oncology are acutely aware of. In fact, the cost of pharmaceuticals went up by about 9% per year. So while they very substantially drove down the costs of emergency room visits and hospitalization, they were barely able to keep up with the rising costs of pharmaceuticals. The second abstract, I think, of particular interest also relates to the cost of drugs. This was a presentation by Bernardo Goulart from Scott Ramsey's group at Fred Hutch Cancer Research Center in Seattle. They are particularly interested in the relationships between the costs of drugs and adherence and other outcomes. Now, previously, there have been several studies published by investigators like Stacy Dusetzina at Vanderbilt showing that as the incremental out-of-pocket costs of drugs goes up that adherence with drugs goes down, i.e. the more that people have to pay out of pocket, the less they take their drugs. And drugs that this has been particularly shown for are oral tyrosine kinase ACE inhibitors. And this has been looked at in a number of different diseases. In this particular study, Dr. Goulart and colleagues looked at the relationship between higher patient out-of-pocket TKI costs and both adherence to drugs, but also overall survival. And consistent with prior studies, they found that greater out-of-pocket costs were again associated with lower adherence. But in this case, they added on the overall survival metric and found that in fact, higher out-of-pocket costs were associated with worse survival. This is important information as we as a country think about how out-of-pocket costs are structured within benefits programs, that in fact, there is a vigorous debate in Washington currently around Medicare Part D and patient out-of-pocket obligations. And this study provides additional evidence that the greater burden our patients face in terms of their financial toxicity from their out-of-pocket costs, the worse their outcomes are going to be. The third abstract that I would like to highlight is by Erin Elizabeth Hahn from Kaiser Permanente Southern California. This study is on a slightly different tack. This is around implementation of distress screening and patient-reported outcomes in clinical practice. Now, many listeners may know that patient-reported outcomes is an area of particular interest to me, but also to many of us who are involved in value-based care because previously, implementation of patient-reported outcomes in clinical practice has been shown to drive down ER visits and hospitalization, to lengthen the amount of time people can tolerate chemotherapy to improve health-related quality of life and to improve overall survival. But one of the challenges around distress screening and patient-reported reported outcomes has been implementation because it is simply difficult logistically to implement collection of information from patients about their symptoms and functioning during routine practice, which is already crowded with all sorts of things that we need to do. So in this study they employed a pragmatic clinical trial design and did a randomized study of using cutting edge implementation science and quality improvement methods to roll out patient-reported outcomes in practice. And they did this in their very large practice. And what they found was that when they used QI principles and implementation science to roll out patient-reported outcomes and distress screening, they had very successful uptake. In fact, 94% of patients who were in the arm that used cutting edge implementation science and QI approaches completed their distress screening and patient-reported outcomes, which was significantly and substantially higher than the arm in control that did not use those approaches. This suggests that for any health system or practice that wants to implement patient-reported outcomes or distress screening and be successful at it really should use our standard QI processes that iteratively work with providers and in this case with patients to make sure that there's understanding, training, uptake, and sustainability. That's great. It sounds like great strides are really being made in value-based care. Were there any other takeaways that you saw as important during the conference? Well, I think that overall across the conference, we saw a lot of enthusiasm around the kind of value-based care initiatives that are reflected by these three abstracts. There's a lot of activity across the country, and also, I should note in Canada because there's a very substantial Canadian representation, to try to build in some of these value-based care approaches and figure out how best to implement them and to try to understand better their impact on costs and utilization. That's great. Again, today, my guest has been Dr. Ethan Basch. Thanks so much for joining us again on our podcast. Thanks so much. Pleasure to be here. And to our listeners, thank you for tuning into the ASCO Daily News podcast. You can find all of our podcasts on <a href="http://podcast.asco.org" rel="nofollow" target="_blank">podcast.asco.org</a>. If you're enjoying the content, we encourage you to rate and review us on Apple podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Dr. Ethan Basch Highlights Key Presentations from the ASCO Quality Care Symposium

ASCO Daily News Podcast Title: ASCO Quality Care Symposium: Key Takeaways from the Meeting with Ethan Basch, MD  Welcome to the ASCO Daily News Podcast. I'm Lauren Davis. And joining me today is Dr. Ethan Basch of the University of North Carolina. He's both a medical oncologist and a health services researcher. Dr. Basch has clinical expertise in prostate cancer. And his research includes patient-reported outcomes, drug regulatory policy, and comparative effectiveness research. Dr. Basch, welcome to the podcast.  Nice to be here.  So you've just returned from the Quality Cancer Symposium. How was this event different from previous years?  The symposium this year was really superb. It was very well attended by a mix of quality officers, clinicians, and researchers. And to me, what was really striking about this year's meeting is that people are really doing applied projects that are multidisciplinary. And what I mean by this is that, in prior years, we'd see very small pilot projects in very narrow areas. We would see projects that maybe were being done just by researchers or projects just being done by community clinicians.  But what we're really seeing now is this coming together of research and practice with a focus on value-based care. And the projects that are being done are very sophisticated and are spanning the continuum from identifying a problem in practice to developing a quality project to measuring and then modifying the outcomes. And so that's really a very exciting development, where we see the research and practice coming together.  What would you say are some of the take-home messages about innovations in care delivery that resonated with you or folks that you spoke with?  I'd say the biggest message from the meeting this year is, it can be done. When there are quality projects that focus around some of the value-based care topics that have risen to the top at this meeting, it was very clear that it is feasible to set up programs and to enlist stakeholders and to actually execute in these areas. For example, there were projects focused around financial toxicity and counseling, around reducing low quality treatment, around navigation, coordination of care, unnecessary ER visits and hospitalizations. And in all of these areas, there was the ability to gather data, develop programs, implement those programs, and collect data. So it could be done.  I think the other take-home message is that there is an increasing number of quality roles in health systems for using data. It used to be that these kinds of roles around value-based care delivery and quality were maybe performed by those who were doing other functions within an organization. And there are an increasing number of dedicated personnel for carrying on this work. Financial toxicity, you just touched on, affects all aspects of cancer care. Are there areas where quality of care is improving despite costs of treatments and services?  So I think that that's a challenging question to answer, because it is a heterogeneous landscape. I mean, certainly, there are areas where quality continues to improve that's disconnected from cost. But what's clear is that it's becoming harder and harder to devote resources to improving quality of care when cost is going up. And of course, when we think about value, value is quality over cost. And so as your cost increases, you have to improve quality that much more in order to provide value.  There were interesting data presented at the meeting showing that more than half of patients with cancer experience substantial financial distress that affects their decisions and compliance, their workplace, and the way that they conduct their lives. And there were practical examples of financial navigation programs that can be integrated into practices to help patients, both to deal with their financial situations and also to deal with their distress that they feel due to financial pressures.  However, it's pretty clear from the evidence that was provided that if costs do not start to become contained, it will become not only difficult to continue to be able to devote resources to quality-- because the resources will be going elsewhere-- but it will be very difficult to help patients to manage their own distress or to ensure that people will be compliant with treatments that require increasing out-of-pocket costs.  Absolutely. In your clinical experience with patients who have cancer, do you think people speak up enough about their needs and expectations?  So unfortunately, research has shown that we, as providers, remain unaware of many of the needs and expectations of our patients. There actually was terrific work from a group in Canada presented at the meeting, at the Quality Symposium, presenting some new quality metrics around patient-centeredness that moved beyond our typical patient satisfaction or patient experiential questionnaires that many of our hospital systems use.  And these metrics look at the extent to which patients feel that their needs and their expectations are being understood and acted upon by care teams. And they found, actually, quite a bit of variability between practices. And they are now intervening at individual practice levels in order to try to see if enhanced navigation services can improve that dimension of care delivery.  That's great. So in our modern age, we have so many communication devices and apps at our hands. But what would you say is the best way to find out how patients are doing and experiencing treatment?  Well, there's a lot of interest in patient-reported outcomes and other electronic communication approaches that can connect practices to patients. As I alluded to in the prior question, it's very common that the practices aren't aware of how patients are feeling, either their side effects of treatment or other symptoms related to disease. And these are missed up to half the time. And so this is a big opportunity.  At this point, I think it's unclear what approach is going to prevail in the end. Will this be part of the patient portal that people can download onto their smart device? Will this be standalone programs that can then send messages to providers? I think it's very early in the days of these kinds of technologies.  But I think that what's exciting is that so many patients are using various kinds of devices to track themselves or to communicate with providers. And I think what we'll see in the years ahead is practices and health systems capitalizing upon this Fitbit culture in order to harness that information for clinical care. But again, I think we're really in early days of this movement.   That's great. Again, my guest today has been Dr. Ethan Basch. Thank you for joining us.  Thank you. I would just like to thank my colleagues, who were instrumental in putting the meeting together, including my colleague, Dr. Monika Krzyzanowska, who was this meeting's chair-- this year's meeting chair-- Dr. Michael Neuss, who was last year's chair. And the two of them were really key to putting together the agenda, as well as our entire group for planning. But I'd also like to thank Carli Gurtshaw and Tony Schweizer at ASCO, who were the staff members who really brought the whole meeting together.  And to our listeners, thank you for tuning in to the ASCO Daily News Podcast. If you're enjoying the content, we encourage you to rate us and review us on Apple Podcasts.  

ASCO Daily News Podcast Title: ASCO Quality Care Symposium: Key Takeaways from the Meeting with Ethan Basch, MD Welcome to the ASCO Daily News Podcast. I'm Lauren Davis. And joining me today is Dr. Ethan Basch of the University of North Carolina. He's both a medical oncologist and a health services researcher. Dr. Basch has clinical expertise in prostate cancer. And his research includes patient-reported outcomes, drug regulatory policy, and comparative effectiveness research. Dr. Basch, welcome to the podcast. Nice to be here. So you've just returned from the Quality Cancer Symposium. How was this event different from previous years? The symposium this year was really superb. It was very well attended by a mix of quality officers, clinicians, and researchers. And to me, what was really striking about this year's meeting is that people are really doing applied projects that are multidisciplinary. And what I mean by this is that, in prior years, we'd see very small pilot projects in very narrow areas. We would see projects that maybe were being done just by researchers or projects just being done by community clinicians. But what we're really seeing now is this coming together of research and practice with a focus on value-based care. And the projects that are being done are very sophisticated and are spanning the continuum from identifying a problem in practice to developing a quality project to measuring and then modifying the outcomes. And so that's really a very exciting development, where we see the research and practice coming together. What would you say are some of the take-home messages about innovations in care delivery that resonated with you or folks that you spoke with? I'd say the biggest message from the meeting this year is, it can be done. When there are quality projects that focus around some of the value-based care topics that have risen to the top at this meeting, it was very clear that it is feasible to set up programs and to enlist stakeholders and to actually execute in these areas. For example, there were projects focused around financial toxicity and counseling, around reducing low quality treatment, around navigation, coordination of care, unnecessary ER visits and hospitalizations. And in all of these areas, there was the ability to gather data, develop programs, implement those programs, and collect data. So it could be done. I think the other take-home message is that there is an increasing number of quality roles in health systems for using data. It used to be that these kinds of roles around value-based care delivery and quality were maybe performed by those who were doing other functions within an organization. And there are an increasing number of dedicated personnel for carrying on this work. Financial toxicity, you just touched on, affects all aspects of cancer care. Are there areas where quality of care is improving despite costs of treatments and services? So I think that that's a challenging question to answer, because it is a heterogeneous landscape. I mean, certainly, there are areas where quality continues to improve that's disconnected from cost. But what's clear is that it's becoming harder and harder to devote resources to improving quality of care when cost is going up. And of course, when we think about value, value is quality over cost. And so as your cost increases, you have to improve quality that much more in order to provide value. There were interesting data presented at the meeting showing that more than half of patients with cancer experience substantial financial distress that affects their decisions and compliance, their workplace, and the way that they conduct their lives. And there were practical examples of financial navigation programs that can be integrated into practices to help patients, both to deal with their financial situations and also to deal with their distress that they feel due to financial pressures. However, it's pretty clear from the evidence that was provided that if costs do not start to become contained, it will become not only difficult to continue to be able to devote resources to quality-- because the resources will be going elsewhere-- but it will be very difficult to help patients to manage their own distress or to ensure that people will be compliant with treatments that require increasing out-of-pocket costs. Absolutely. In your clinical experience with patients who have cancer, do you think people speak up enough about their needs and expectations? So unfortunately, research has shown that we, as providers, remain unaware of many of the needs and expectations of our patients. There actually was terrific work from a group in Canada presented at the meeting, at the Quality Symposium, presenting some new quality metrics around patient-centeredness that moved beyond our typical patient satisfaction or patient experiential questionnaires that many of our hospital systems use. And these metrics look at the extent to which patients feel that their needs and their expectations are being understood and acted upon by care teams. And they found, actually, quite a bit of variability between practices. And they are now intervening at individual practice levels in order to try to see if enhanced navigation services can improve that dimension of care delivery. That's great. So in our modern age, we have so many communication devices and apps at our hands. But what would you say is the best way to find out how patients are doing and experiencing treatment? Well, there's a lot of interest in patient-reported outcomes and other electronic communication approaches that can connect practices to patients. As I alluded to in the prior question, it's very common that the practices aren't aware of how patients are feeling, either their side effects of treatment or other symptoms related to disease. And these are missed up to half the time. And so this is a big opportunity. At this point, I think it's unclear what approach is going to prevail in the end. Will this be part of the patient portal that people can download onto their smart device? Will this be standalone programs that can then send messages to providers? I think it's very early in the days of these kinds of technologies. But I think that what's exciting is that so many patients are using various kinds of devices to track themselves or to communicate with providers. And I think what we'll see in the years ahead is practices and health systems capitalizing upon this Fitbit culture in order to harness that information for clinical care. But again, I think we're really in early days of this movement. That's great. Again, my guest today has been Dr. Ethan Basch. Thank you for joining us. Thank you. I would just like to thank my colleagues, who were instrumental in putting the meeting together, including my colleague, Dr. Monika Krzyzanowska, who was this meeting's chair-- this year's meeting chair-- Dr. Michael Neuss, who was last year's chair. And the two of them were really key to putting together the agenda, as well as our entire group for planning. But I'd also like to thank Carli Gurtshaw and Tony Schweizer at ASCO, who were the staff members who really brought the whole meeting together. And to our listeners, thank you for tuning in to the ASCO Daily News Podcast. If you're enjoying the content, we encourage you to rate us and review us on Apple Podcasts.

ASCO Quality Care Symposium: Key Takeaways from the Meeting with Ethan Basch, MD