NJ Doctor, Insurer Team Up to Improve Access to Cancer-Treatment Innovations

Andrew Kitchenman | December 7, 2015 | Health Care
Hackensack UMC-based oncologist’s company enables healthcare providers to compare individual patients’ cases to nationwide data

genetic marker cancer
It can be hard for doctors treating cancer patients to keep up with rapidly evolving tests and treatments, particularly new techniques that can target specific genetic mutations associated with the disease.

What’s more, doctors can benefit greatly by seeing how their patients – both in terms of treatments and health outcomes – compare to patients nationwide. But that information is difficult to come by.

A new company started by a New Jersey oncologist hopes to make the information more readily available.

A company founded by Dr. Andrew L. Pecora, chief innovations officer at Hackensack University Medical Center’s John Theurer Cancer Center, has drawn the interest – and funding – of Horizon Blue Cross Blue Shield of New Jersey executives who believe patients, hospitals, and insurers across the state can all benefit from the approach.

Pecora’s company, COTA Inc., has developed a system in which each patient’s disease is converted into a number. This number is based on the stage of the cancer; details about the disease; and patient characteristics like their age and sex. This number, called a COTA nodal address, makes it easier to compare patients, study cancers, and facilitate the use of what is called “personalized medicine.”

“You got to measure things — I mean, who could fix something if you don’t even know it’s broken?” said Pecora.

As medical science finds more genetic markers for different cancers, it’s developing medications that are more targeted than traditional chemotherapy.

The COTA system has the greatest potential to help patients with the cancers for which researchers have found genetic markers, Pecora said. That’s because it provides much more detailed information that the traditional medical coding and billing system, known as ICD-10, which even in its recent update only contains generic information about different cancers.

Pecora cited early evidence that a treatment for a specific type of lung cancer has more than tripled patients’ average survival time, from 11 months to more than three years. That same new treatment has also reduced the overall cost of treatment, even though the medication used is more expensive than conventional treatments, because patients undergoing traditional treatments spend more time in the hospital.
“This rhetoric out there that drugs cost too much — it may be true in some cases, but we’ve got to be careful,” Pecora said.

As an example of how COTA’s system can be used, Pecora pointed to a case in which different doctors treated five patients with identical diseases. Even though these patients were in distant hospitals, their cases could be tracked and compared instantly using the numbers generated by the COTA system.

While the patients had similar health outcomes, treatments for two of the patients were much more expensive. And with insurers shifting toward a value-based system in which doctors are paid based in part on keeping patients healthy while reducing the cost of healthcare, Pecora says they will have an incentive to use the comparative COTA information to help them provide more cost-efficient care.

“Your patients are being benchmarked against other patients in other parts of the country that are exactly the same, and here’s what you are doing different, and here’s the consequence,” Pecora said in explaining what doctors might be able to learn from the information.

Dr. Glenn D. Pomerantz, Horizon’s chief medical officer, is enthusiastic about COTA.

Insurers traditionally couldn’t access the data necessary to analyze whether doctors were using the most up-to-date “personalized medicine” treatments on their patients. But with the COTA data, Horizon may be able to point doctors toward treatments that are more expensive in the short run, but will lead to better value for patients, providers, and insurers in the long run.

“I need to make sure all these cancer patients that we insure … are getting the right targeted sequencing, they’re getting matched properly, and they’re getting treated,” Pomerantz said. “And then we should reward commensurately those physicians, those oncologists, those institutions that are doing it the best. And make that public in the right way.”

Pomerantz linked the expansion of “personalized medicine” with Horizon’s broader shift from paying for healthcare based on the amount of services that providers deliver toward paying for “value,” a term that’s being used to describe a combination of the cost of treatments and the quality of the treatment, in terms of the patients’ health and satisfaction.

Pecora credited Horizon’s support for helping expand his company from three employees to nearly 100. Its office is in New York City.

“Kudos to Horizon Blue Cross — not only did they believe in this, they actually invested in it and supported this,” he said.

Pecora and Pomerantz discussed the issue during a recent conference hosted by the nonprofit New Jersey Health Care Quality Institute.

During a later panel discussion, both doctors said that having better data improves how doctors treat patients, and makes it easier for doctors to educate patients about their conditions.

Pomerantz said that the “value-based” approach to paying doctors allows them to determine how best to spend their time with patients, since it rewards them for whatever will lead to the best outcomes for patients, rather than just for what services they deliver.

Dr. Michael Hall, another panelist, added that the advances in personalized treatments make it important that researchers find more genetic markers that allow targeted treatments for cancers. While some cancers — like lung, breast, colon, and prostate – are already the subjects of screenings for different treatments, others, such as many liver cancers, aren’t as well understood.

“I do think it’s the future,” Hall said. “It’s just a question of more research to develop those markers.”

The basic architecture of the COTA system could be expanded to other diseases beyond cancer, and could prove useful in areas like behavioral healthcare, Pecora said.

He sees the COTA system helping to reduce the 30 percent of wasteful healthcare spending based on a widely recognized national estimate.

“There are two ways you waste dollars: You either do something that doesn’t need to be done or you don’t do something that should be done,” such as personalized medicine, Pecora said.