With community oncology ‘at risk’, alliance outlines prescription for health care reform
Key takeaways:
- Debra Patt, MD, PhD, MBA, FASCO, emphasized the importance of COA’s Prescription for Health Care Reform.
- She urged community oncologists to take an interest in policy issues that could affect their practices.
Debra Patt, MD, PhD, MBA, FASCO, has often found her career has placed her at the intersection of public policy and clinical informatics.
“I think I am like a ‘Rosetta Stone’ between disciplines, which enables me to address some of the very important issues we’re facing,” Patt — who took over as president of Community Oncology Alliance (COA) on Jan. 1 — told Healio. “We need to navigate some of the new policies we are seeing — whether they are executive orders or at the state level — and navigate the landscape to continue to serve our patients.”
Patt — a breast cancer specialist who will serve a 1-year term as COA president — has led a private, independent oncology practice for the past 20 years. She currently is executive vice president at Texas Oncology, which has 300 sites of service across the state.
Patt also serves as medical director for public policy for The US Oncology Network. She has testified before U.S. House and Senate committees about the importance of protecting access to care for people with cancer.
“The dream of modern cancer therapy is one where cancer isn’t taking patients’ lives and cancer therapy is not taking their livelihoods,” Patt said. “Community oncology practices do a great job of that. Patients are able to get their labs and treatments and also go to work, pick up their kids from soccer practice, and be at home for dinner with their families.”
‘We’d like to see transparency’
Patt pledged her commitment to advancing COA’s objectives — specifically those outlined in the COA Prescription for Health Care Reform, released in February.
The five-part plan is designed to serve as a blueprint that identifies challenges facing the health care system, highlights the consequences for patients, and outlines actionable solutions for Congress.
Oncologists, pharmacists practice administrators and other experts provided insights used to develop the plan, which examines hospital consolidation, insurer/pharmacy benefit manager (PBM) consolidation and market dominance, fixing physician reimbursement and workforce shortages.
“The idea for the COA Prescription for Healthcare Reform came way before the presidential election,” Patt said. “We were trying to be more intentional about how we think about policy reform over time. Recognizing that consolidation continues to be happening — and that it poses a threat to independent oncology practices — we put together [this plan].”
Consolidations — frequently driven by financial motivations — are not concordant with the goal of accessible, quality patient care, Patt said.
“Hospitals are driven to consolidate independent community oncology practices because of the financial drivers that make it very lucrative for them to go into the cancer space,” she said. “Frequently, the cost of care in a hospital system is two to three times what it is in an independent practice.”
PBMs represent another health reform priority for COA this year, Patt said.
“The Federal Trade Commission recently released a report on PBMs, and we understand how PBMs are interacting with [the 340B Drug Pricing Program],” she said. “There are spread pricing arrangements — there are markups. We’re advocating for policy changes to 340B. It was meant to serve vulnerable patients, not to line the pockets of pharmacy benefit managers.”
The consolidation and dominance of PBMs in the current health care model also is apparent in the steering of oral oncolytic drugs — which are prescribed to about one-third of patients — toward PBMs, Patt said.
“Over half of oral oncolytic drugs are steered to PBMs and their vertically integrated specialty pharmacies, instead of being filled by medically integrated dispensing pharmacies,” Patt said. “As a result of this, we see delays in care, we see inappropriate fills that facilitate waste, and we see delays in prior authorization.”
The financial motivation of PBMs’ marketplace dominance and consolidation makes all of these vulnerabilities much starker, Patt said.
“We’d like to see transparency in that space, and we’d like to see good policy emerge,” Patt said.
Community oncology ‘at risk’
Patt discussed ways in which community oncologists can work to advance COA’s goals for the year ahead.
To start, she advised communication and connection between community-based clinicians.
“In my 20 years in community practice, I have learned that we all navigate the complicated landscape of health care much better when we talk to each other and communicate,” Patt said. “A great place to do that is the COA Annual Conference.”
The conference — which will take place April 29-30 in Orlando — will foster conversation and information sharing among a wide variety of stakeholders in oncology, including physicians, nurses, administrators and pharmacists.
Patt also urged community oncologists to support COA’s efforts toward health care reform during a time of political change and legislative uncertainty.
“It’s important for independent, community oncology practices to engage with COA, because we are an incredible resource,” she said. “Community oncology is at risk. You’re either at the table or you’re on the menu.”
References:
- Community Oncology Alliance. COA elects new president, officers and board members (press release). Available at: https://mycoa.communityoncology.org/news-updates/press-releases/coa-elects-new-president-officers-and-board-members-2025. Published Dec 18, 2024. Accessed Feb 19, 2025.
For more information:
Debra Patt, MD, PhD, MBA, FASCO, can be reached at debra.patt@usoncology.com.
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