Oncology is experiencing unprecedented change. Recent breakthroughs in immunotherapy have dramatically changed our view of what is possible. Patients who previously were on their deathbeds now have hope while others have experienced miraculous turnarounds in their prognoses.
Recently, "60 Minutes" aired a segment featuring researchers from Duke University who were using the polio virus to treat glioblastoma. At the Mayo Clinic, there are patients whose multiple myeloma is in remission, thanks to clinical trials involving injections of a highly concentrated dose of measles. Then there is Emma Whitehead, who underwent a last-resort experimental treatment for her acute lymphoblastic leukemia. In April 2012, scientists at the University of Pennsylvania used a modified HIV virus to genetically reprogram her white blood cells in the hope that the modified cells would attack and destroy her cancer. They did: As of February 2015, Whitehead remained cancer-free.
With the Affordable Care Act, the rise in accountable care organizations and the change in state government cancer care funding, immunotherapy is just one piece of the puzzle in the highly complex world of oncology. Shifts in treatment and policy will require organizations involved in all levels of cancer care to rethink their investments and infrastructure. The evolving cancer care landscape necessitates leaders in cancer care — health care executives, director-level managers and health policymakers — to solidify their strategic capabilities and foresight.
Advances in Treatment
Cancer care is trending away from traditional chemotherapy, radiation and surgery. An early-phase clinical trial at Dana-Farber Cancer Institute in Boston involving 23 patients with relapsed or treatment-resistant Hodgkin's lymphoma recently found that 87 percent of patients experienced complete or partial remission. Nearly all the patients — who had exhausted other treatment options — benefited from the immunotherapy.
Late last year, Memorial Sloan Kettering Cancer Center researchers contributed key advances to the understanding of why some patients respond to ipilimumab, an immunotherapy drug, while others do not. Their November 2014 study showed that patients who respond to ipilimumab have cancer cells that carry a high number of gene mutations — some of which make tumors more visible to the immune system and, therefore, easier to fight. Eventually, these findings could translate into a diagnostic test to detect gene mutations in melanoma patients, which would help doctors and patients to make more informed treatment decisions. New technology and more targeted cancer drugs are replacing the traditional one-size-fits-all chemotherapy.
President Obama's 2015 State of the Union address significantly supported targeted, personalized medicine. The president urged Congress to invest heavily in precision medicine, saying, "I want the country that eliminated polio and mapped the human genome to lead a new era of medicine — one that delivers the right treatment at the right time." The new precision medicine initiative portrays a future of cancer care that focuses on targeted immunotherapies and genetic screenings.
The Need for Strategic Leadership
Changing treatments will affect patients, payers and caregivers. The system is interdependent and, as health policy and health systems trend toward bundled payments, coordination within health care will increase, further amplifying the effects across the spectrum.
One thing is a guarantee: Cancer care will be vastly different five years from today. It is critical for cancer care leaders to anticipate these developments and challenge current mental models so they are prepared to take action and use the innovation around them.
First, leaders in cancer care must challenge their current frames of thinking. Cancer center leaders have seen unexpected and groundbreaking partnerships with the implementation of ACOs and clinical integration agreements. ACOs in oncology and other forms of secondary care remain in the experimental phase. However, the success of ACOs in primary care encourages trials in the more expensive fields, including oncology. MD Anderson has responded accordingly with a pilot ACO that implements a single, bundled fee for head and neck cancer treatments. Driven by ACOs and market consolidation, traditional competitive dynamics that are often identified by geography and industry are breaking down.
Furthermore, the expansion of big data and emphasis on patient outcomes, along with out-of-pocket payers' demanding higher-quality services, foster innovative strategic alliances in an environment of intense competition for delivering the most state-of-the-art care. Therefore, leaders in cancer care must question their current models of competitive dynamics. By developing alternative views of the future and challenging conventional wisdom of what has worked in the past, oncology leaders will surface new opportunities for partnerships in a cancer care network's ecosystem.
Finally, to navigate the changing health care environment and remain competitive, leaders in cancer care need to interpret how advancements in innovation will impact their businesses and the industry as a whole. Strategic leaders must pay attention to signals from all parts of the health care value chain — pharmaceuticals, cancer research and payer structure.
For instance, successful immunotherapy research trials that are treating solid tumors and subsequent partnerships between payers and cancer centers suggest that the oncology field is shifting to heavily favor immunotherapy over chemotherapy. Due in part to the price structuring of oncology care, immunotherapy treatments cannot be administered in effective regimens and remain an affordable option for cancer patients in the current fee-for-service model. As oncology shifts to more bundled payments and immunotherapy treatments provide better patient outcomes, the standard of care will shift to higher demands in immunotherapy services. Leaders in cancer care should synthesize all the inputs they have to stay ahead of oncology demands.
In light of innovations in oncology, hospital and health network leaders should think about the following:
Number and effectiveness of new treatments. Will the regulatory approval process for immunotherapy drugs become more efficient, or increasingly complex and time-consuming?
Organizations that are agile enough to respond to unexpected drug approvals or delays are more likely to thrive in cancer care. Alternative playbooks and contingency plans enhance an organization's strategic agility.
Patient role in innovation. Will the regulatory process leverage tools and methodologies that accurately and reliably measure patient preferences for treating and diagnosing cancer?
Health systems and hospitals that stay informed of shifting patient preferences can respond to changing demands faster than their competitors and remain at the forefront of innovation.
Financial burden of cancer care. Will the number of underinsured grow as more patients have high deductibles or out-of-pocket expenses relative to their income?
Organizations able to respond to shifting patient volumes and payer mixes will be less likely to face disruption from competitor partnerships and mergers.
Risks and Rewards
As investment in oncology innovation continues to increase, so does the cost of care delivery. According to a report by IMS Health, the U.S. market for oncology drugs increased 5.3 percent in 2014 to comprise more than 10 percent of the United States' total market for all drugs.
Cancer care for America's aging population inevitably will require a bigger piece of the health care spend pie. As costs grow, however, leaders at cancer centers, pharmaceutical companies and research labs will face difficult decisions in making cuts and scaling back. In addition, patient volumes and payer mixes will shift dramatically; the ability to predict peak sales for new therapies will become cloudier.
The situation provides opportunity for cancer care leaders — executives, research directors and pharmaceutical executives — in that innovation will be rewarded. However, it also creates risks in that costs will be cut, as U.S. health care spending will not continue on its current slope.
Cancer care leaders must hone their capabilities and strategic skills in navigating this complex and uncertain environment. New developments in cancer treatment pose threats of disruption, but also create tremendous opportunity for agile organizations that can hone innovation. It is the job of today's leaders to navigate this uncertainty and position their organizations to innovate for the highest impact. It is the combination of these innovative breakthroughs and strategic leadership that will allow cancer care to extend patient lives and provide affordable treatment options for all patients.
Toomas Truumees is the chief talent officer and senior managing partner, and Eric Skoritowski is an associate at Decision Strategies International, a consulting and training firm specializing in leadership development and strategy formulation. They are based in Philadelphia.