Imagine 2019 - (Presentation Slides)

#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

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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

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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!

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Thank You Silver Sponsors!

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Thank You Event Partners!

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