#ImagineSession
Patient & Caregiver Panel
Mario Muredda Moderator
CEO • Harrison & Star
#ImagineSession
Travis Hicks
Cancer Caregiver
Patrice Kelly
Cancer Caregiver & Breast Cancer Patient
Erin McElhenney
Young Adult Patient
Nichole Millea
Cancer Caregiver
Q&A
Travis Hicks
Cancer Caregiver
Patrice Kelly
Cancer Caregiver & Breast Cancer Patient
#ImagineSession
Erin McElhenney
Young Adult Patient
Nichole Millea
Cancer Caregiver
Keynote Speaker Yousuf Zafar MD, MHS Duke Cancer Center #ImagineSession
>
L A I C N A FIN FIRST, DO NO HARM Yousuf Zafar, MD, MHS, FASCO Associate Professor of Medicine, Public Policy, & Population Health Science Director of Healthcare Innovation Duke Cancer Institute
Employment (spouse)
Shattuck Labs
Advisory Board
AIM Specialty Health Vivor, LLC SamFund
Board of Directors
Family Reach Foundation
Research funding
NIH AstraZeneca
Board Member
Copernicus-WCG IRB
Consulting
RTI, Quintiles McKesson
Used with permission
Why? 1.
2.
3.
Treatment is expensive Cost-sharing is increasing ?
$11,000
$3232 $289 1980
2000
2019 P Bach. Memorial Sloan Kettering Drug Pricing Lab
Patients receiving immune therapy 212,473 158,381 96,235 36,191 2403
2014
2015
2016
2017
2018
IQVIA 2019
$13,000 a month Nature, 2015
Why? 1.
2.
Treatment is expensive Cost-sharing is increasing
Employer contribution to premiums 270%
300% 250% 200% 150% 100% 50% 0% 1999
2002
2005
2008
2011
2014
2017 Kaiser Employer Health Benefits Survey, 2017
$1,400
Deductibles have tripled
$1,200 $1,000 $800 $600 $400 $200 $2006
2008
2010
2012
2014
2016 Kaiser Employer Health Benefits Survey, 2017
Four-tiered formularies
23%
11% 5% 4% 3%
13% 14% 14%
7% 7%
0% 20032004200520062007200820092010201120122013 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2013
Average cumulative patient out-of-pocket costs $12,000
Lung
$10,000
Colorectal
$8,000
Breast
$6,000 $4,000 $2,000 $-
0
5
11
17
23
29
Months from diagnosis
35
41
47 Milliman Report, 2017
MONTHLY BANKRUPTCY RATES, WESTERN WASHINGTON STATE
Ramsey et al, Health Affairs 2013
MONTHLY BANKRUPTCY RATES, WESTERN WASHINGTON STATE
2.65x
RISK OF
BANKRUPTCY
Ramsey et al, Health Affairs 2013
MONTHLY BANKRUPTCY RATES, WESTERN WASHINGTON STATE
7,570
matched patients
79 % greater mortality risk HR 1.79 (1.64, 1.96) Ramsey et al, JCO 2015
Extreme financial distress
?
Greater risk of mortality
Extreme financial distress
Wellbeing
Greater risk of mortality
68%
Foregone vacations Cut grocery expenses
46%
Depleted savings
46% n=254 Zafar et al, Oncologist 2013
“[I have] gone without clothing, food and visiting my children and grandchildren…, turned down trips, cut down on utilities so the bills would not be so high, not bought the better foods like meat and vegetables….” “I became homeless and our entire family has had to live with a friend several times.”
50%
willing to declare bankruptcy
39%
willing to sell their home
73%
willing to spend less on food or clothing Chino F et al, JAMA Onc 2017
Extreme financial distress
Health related quality of life
Greater risk of mortality
High financial burden: Quality of life among patients with active cancer and survivors adjusted beta 0.06 EQ-5D unit per financial burden category; p<.001 n=1000 Zafar et al, JOP 2014
High financial burden:
Symptom burden Lung cancer: Adjusted mean difference 5.25 [95% CI, 3.29 to .22] Colorectal cancer: Adjusted mean difference 5.31 [95% CI, 3.58 to 7.04]
n=1000 Lathan et al, JCO 2016
Extreme financial distress
Quality of care
Greater risk of mortality
70%
higher likelihood of non-adherence Upper 75th percentile >$53/month aRR, 1.70; 95% CI, 1.30 to 2.22 Dusetzina et al, JCO 2013
27
were % non-adherent n=254
Bestvina et al, J Onc Pract 2014
22%
did not fill a prescription due to cost
25%
took less medication to make the prescription last longer Bestvina et al, J Onc Pract 2014
Well-being
Extreme financial distress
Healthrelated quality of life Quality of care
?
Greater risk of mortality
Buying less clothing
Buying less food
Financial distress Working longer hours
Spread out chemotherapy Cutting out vacations appointments Missed appointments
Bankruptcy Spending savings
Using credit
Declining tests
Taking fewer medications
Using other peopleâ&#x20AC;&#x2122;s medications
Selling property Replaced prescriptions with over the counter medications
Borrowing from friends or family
Non-adherence
Delaying care
Buying less clothing
Buying less food
Financial distress Working longer hours
Spread out chemotherapy Cutting out vacations appointments Missed appointments
INTERVENE Bankruptcy
Spending savings
Using credit
Declining tests
Taking fewer medications
Using other peopleâ&#x20AC;&#x2122;s medications
Selling property Replaced prescriptions with over the counter medications
Borrowing from friends or family
Non-adherence
Delaying care
Policy Provider Patient Zafar SY, JNCI 2015
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
OUTCOMES-BASED PRICING
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
In order to promote competitionâ&#x20AC;Ś the Secretary [of HHS]: 1. may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors; and 2. may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.
Median household income in NC: $52,752 2019 ACA annual out-of-pocket max: $7,900
15%
Datausa.io Healthcare.gov
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
High value
Low value
Chernew M et al, Health Affairs 2007
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
MANUFACTURERS GOVERNMENT INSURERS HEALTH SYSTEMS
PRICE TRANSPARENCY
Photo: Nick Veasey, TIME, 2013
Policy Provider Patient Zafar SY, JNCI 2015
Prevent fatigue
Assess fatigue
Reduce fatigue
Prevent financial toxicity
Assess financial toxicity
Reduce financial toxicity
Prevent financial toxicity
Assess financial toxicity
Reduce financial toxicity
Focus on
high-value
Don’t use cancer-directed therapy for solid tumor patients with: • low performance status (3 or 4) • no benefit from prior evidence-based interventions • not eligible for a clinical trial • no strong evidence supporting the clinical value of further anti-cancer treatment. ASCO Choosing Wisely
Goals of care
Prevent financial toxicity
Assess financial toxicity
Reduce financial toxicity
5 month improvement in overall survival HR 0.83 (95%CI 0.70-.99)
n=766
Basch et al, JAMA 2017
Improvement in overall survival Patient-reported outcomes Nivolumab (SCCHN) Pembrolizumab (NSCLC) Atezolizumab (NSCLC) Cabozantinib (RCC) Eribulin (liposarcoma) 0
2
4
6
Months
Adapted from Krzyzanowska, ASCO 2017
Prevent financial toxicity
Assess financial toxicity
Reduce financial toxicity
52%
desire a cost discussion with oncologists
19%
actually have a cost discussion n=299 Zafar et al, AJMC, 2015
Why didn’t you discuss costs?
34%
Want the best care
18%
Not my doctor’s job
18%
My doctor can’t help Talked to someone else Embarrassed
9% 9% Zafar et al, AJMC, 2015
57%
reported lower costs due to a cost discussion with their oncologist
n=299 Zafar et al, AJMC, 2015
How were costs decreased? Decreased frequency of MD visits Changed tests or decreased frequency Switched to less expensive meds Team appealed to insurance Referred to financial assistance
6% 13% 19% 25% 53% Zafar et al, AJMC, 2015
TALK ABOUT COSTS
KNOWLEDGE BASE
FINANCIAL NAVIGATION
COMMUNITY
Used with permission
Q&A Yousuf Zafar MD, MHS Duke Cancer Center #ImagineSession
Collaboration Panel
Mario Muredda Moderator
CEO • Harrison & Star
#ImagineSession
Kari McHugh
Senior Director, Customer & Community Relations • Dunkin’ Brands
Laura Ellis
Global Medical Stays Manager • Airbnb
H. Art Taylor
President & CEO • BBB Wise Giving Alliance
Questions?
Kari McHugh
Senior Director, Customer & Community Relations • Dunkin’ Brands
#ImagineSession
Laura Ellis
Global Medical Stays Manager • Airbnb
H. Art Taylor
President & CEO • BBB Wise Giving Alliance
Imagine Session History Rosie Cunningham Director of Strategic Initiatives Family Reach #ImagineSession
The Imagine Community Abbvie ACCC Addi’s Faith Foundation Airbnb AllianceRx Walgreens Prime AltaSource American Cancer Society Cancer Action Network AmeriCatalyst LLC AmerisourceBergen AOL Arthur J. Gallagher Astrellas Pharma B&W Watercress Bain Capital Bayer Biden Cancer Initiative Blue Cross NC Boston Children’s Hospital Brafton BriovaRX Bristol Myers Squibb Cancer Support Community CancerCare Cape Cod Healthcare Celegene Corporation Cencer of Cancer Systems Biology Children’s Hospital Orange County Claire’s Army Cloudhealth by VMWare CMC Food Community Oncology Alliance Columbia GRC
Craft’d Company CVS Health Dana-Farber/Boston Children’s Department of Housing & Community Development Direct Relief Duke Cancer Center Duke University Dunkin’ Brands Eaton Vance Ellie Fund Epicenter Experience Ethan Lindberg Foundation Eveo Exactech Expect Miracles Foundation EY-Parthenon Fidelity Charitable Financial Planning Association First Descents Food is Medicine Foundation for Financial Planning Foundation Medicine Freddie Mac Friends of Karen FTPA Genentech Goodwin Proctor LLP GRYT Health Hands for Holly Memorial Fun Harrison & Star Health Care Navigator Helping our Women
Hutchinson Institute for Outcomes Research IBM Watson Jack Morton Worldwide Janssen Oncology Joe Andruzzi Foundation Johns Hopkins Bloomberg School of Public Health JUST TRYAN IT Kite Lash Group, a part of Amerisource Bergen Leukemia Texas Life is Good Living Beyond Breast Cancer Lyft Massachusetts General Hospital Massachusetts State Senate MBA Open Doors Foundation Metronic Microsoft MK3 Creative Morgan Lewis Morgan Stanley Motion Play Ventures New Day Foundation for Families Oath Office of Senator Jason Lewis Oliver Wyman One Mission Parthenon Patient Advocate Foundation Patient Alliances
Pfizer Vertex Phorix Vivor PhRMa WCBS NYC Reebok WebMD Resilience Gives Wells Fargo Resound Westgate Consulting Rightpoint Xcenda RX 4 Good Zipcar Samsung Slalom Snider Foundation Solomon McCown & Co. Stacy’s Juice Bar State Street Suzette Rothberg Consulting, LLC T3 Advisors Tailor Med Takeda Oncology Taurus Investment Holdings Tennessee Breast Cancer Coalition The MBA Opens Doors Foundation The Navectus Group The Pink Fund The Same Fund This Star Won’t Go Out Thrive Earlier Detection Corp. TJ Maxx Triage Cancer Trillium Brewing Company Tufts Medical Center UnitedHealth Group UNC Medical Center Urban Edge
Imagine Session History Awareness
Corporate Ecosystem
Awareness
2018
2016
2017
TODAY Mortgage Relief Pilot
Financial Planning for Cancer Program Awareness
The LiFT Network
#ImagineSession
Driving progress forward, togetherâ&#x20AC;Ś.
Housing Coalition
What’s Next? • Financial Planning for Cancer • LiFT Network • Corporate Ecosystem • Housing • Awareness #ImagineSession
Ground Rules • No idea is a bad idea – think outside the box • Create space in your group to think freely • The more ideas the better
#ImagineSession
Breakout Sessions Housing Breakout
● Pod #3 ● Facilitators: Tracy Foster & Corey Fick
Awareness Breakout
● Assembly Room ● Facilitators: Colleen Saville & Francis Ma
Ecosystem Breakout
● Lounge ● Facilitators: Amy Choi & Liz Herrig
LiFT Network Breakout ● Pod #1 ● Facilitators: H. Art Taylor & Joanna Scott
Financial Planning Breakout ● Assembly Room ● Facilitators: Suzette Rothberg & Andrea Incudine
Event Closing Carla Tardif CEO Family Reach #ImagineSession
Special Guests
Kristen & Paisley Benjamin #ImagineSession
Thank You Gold Sponsors!
#ImagineSession
Thank You Silver Sponsors!
#ImagineSession
Thank You Event Partners!
#ImagineSession
#ImagineSession