Newswise — FORT WASHINGTON, PA [April 16, 2018] — The National Comprehensive Cancer Network® (NCCN®) recently convened a roundtable discussion on trends for delivering quality care and value for people with cancer, in the face of climbing costs. The discussion took place during the NCCN 23rd Annual Conference in Orlando. Clifford Goodman, PhD, Senior Vice President of The Lewin Group served as moderator for the panel, which included the following speakers:
- Travis Bray, PhD, Founder, Hereditary Colon Cancer Foundation
- Randy Burkholder, Vice President of Policy and Research, PhRMA
- Ron Kline, MD, FAAP, Medical Officer, Center for Medicare & Medicaid Innovation (CMMI), Centers for Medicare & Medicaid Services (CMS)
- Daniel Mirda, MD, President, Association of Northern California Oncologists
- Michael Neuss, MD, Chief Medical Officer, Vanderbilt-Ingram Cancer Center
- Lee Newcomer, MD, MHA, Former Senior Vice President, Oncology & Genetics, UnitedHealthcare
- Bhuvana Sagar, MD, National Medical Executive, Cigna Health Care
The multi-stakeholder panel discussion was preceded by individual keynote addresses from Drs. Kline and Newcomer, who provided the CMS and Managed Care perspectives on transforming cancer care in America, with a look at where we’ve been, where we are right now, and where we could go in the future.
In Dr. Kline’s address, he explained how CMMI’s Oncology Care Model (OCM) encourages clinicians to focus on high quality and high value care. He explained how OCM adjusts for novel therapies, which are likely to include a higher price tag, and detailed how high value practices can earn performance-based payments within the system. Dr. Kline also pointed out that CMMI has invested significantly in the first performance period in Monthly Enhanced Oncology Service (MEOS) payments toward these efforts, and is committed to self-examination and improvement.
“We are listening to you,” said Dr. Kline, addressing a room filled with oncology health care providers. “We are learning, and we’re trying to improve care for cancer patients.”
Immediately following that address, Dr. Newcomer – who recently retired from his role with UnitedHealthcare – spelled out his concerns for cancer care spending in the United States.
“If we don’t fix this problem and return to some kind of balance, we will have a crisis,” Dr. Newcomer said. “Leadership is absolutely essential. Everyone has to be all in.”
Dr. Newcomer detailed some pilot programs from UnitedHealthcare involving alternative payment structures, which have had mixed results. He then transitioned to broader policy issues and discussed the market restrictions that reduce all payers’ abilities to negotiate drug pricing, and called for the removal of insurance regulations that encourage drug price increases. Dr. Newcomer also quoted from the farewell speech of President Dwight D. Eisenhower, stating, “As we peer into the future, we must avoid the impulse to live only for today, plundering the resources of tomorrow.”
How best to preserve the ‘resources of tomorrow’ sparked a spirited conversation during the subsequent emerging issues roundtable. Stakeholders representing patient advocates, public and private payers, large and small clinical facilities, and the pharmaceutical industry did not always see eye-to-eye on the definition of “value” in cancer care, nor on how to provide and preserve it.
“What we mean by value is delivering better treatments for patients that extend their lives and reduce toxicity,” explained Burkholder. “When you consider the gains we are making through better treatments relative to what we are spending, there’s no doubt they represent significant value.” However, others on the panel questioned the value of life-saving treatments, if they are priced beyond what patients are able to pay.
“Patients come to me and say that they can’t afford their cancer therapy,” said Dr. Mirda. “Even when insurance covers it, their copay is insurmountable.” Dr. Bray agreed, “There was an article that said 79% of people being treated with cancer report moderate-to-catastrophic financial burden.”
Dr. Kline offered up an equation: “Value is outcome over cost. We create better value by asking: can you accomplish the same goal at a lower cost?” Dr. Sagar echoed his point about finding ways within treatment practices to reduce costs without diminishing quality. “Payers and providers are working together more collaboratively, toward a common goal of improving patient outcomes,” said Dr. Sagar. “Together we are designing programs that effectively align incentives with evidence-based, appropriate care to achieve better results.”
The panelists agreed on the importance of making more data available to both patients and physicians. “It’s critical for physicians to understand cost and effectiveness,” said Dr. Mirda. “Physicians need to have some assistance from an administrative layer within their practice, in order to understand this.” Dr. Neuss agreed: “We are making progress, but where we haven’t made enough progress is in measurement. Having a visual, having an understanding of the costs associated with care, broken down by different categories of patients, is how we will identify best practices moving forward.”
Another area of agreement for reducing costs is through more early-intervention and prevention. According to Dr. Bray, “Ten percent of cancer is preventable. You can unburden people by preventing it.”
In the final moments, panelists put forth a few key takeaways, calling for better access to data for both patients and providers, taking a comprehensive approach from diagnosis to end-of-life with transparent cost information along that continuum, learning from what has worked elsewhere, and making sure these discussions include input from patient advocates.
Visit NCCN.org to learn more about the tools NCCN provides to encourage prevention and enable shared decision-making between patients and providers, including the NCCN Guidelines for Patients®, NCCN Guidelines with Evidence Blocks™, NCCN Categories of Preference, and NCCN Guidelines for Prevention and Risk Reduction. Join the conversation online with the hashtag #NCCNac18.
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About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.
The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
 The article in Health Affairs can be found at https://www.healthaffairs.org/do/10.1377/hblog20170523.060220/full/, citing research from: Zafar SY, Peppercorn JM, Schrag D, et al. The financial toxicity of cancer treatment: a pilot study assessing out‐of‐pocket expenses and the insured cancer patient's experience. Oncologist. 2013;18:381–390. https://www.ncbi.nlm.nih.gov/pubmed/23442307.