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NCCN 2016

The Politics of Cancer Care in 2016

Surabhi Dangi-Garimella, PhD
Four panelists and 2 moderators discussed the issues surrounding cancer and healthcare in the lead-up to the 2016 presidential election during the National Comprehensive Cancer Network 21st Annual Conference.
Fowler wants greater stakeholder collaboration—including the pharmaceutical industry. “We would like to be viewed as a partner at the table with payers and academia,” she said. “We don’t share a lot of data as yet, but this is one piece that’s still missing and there’s room for improvement there.”

Fowler said that fee for service (FFS) remains the chassis of our payment system, and if we expect improvements, “it would need almost a wholescale revisiting of our payment system.”

Chen brought up the Medicare Part B demonstration project that was recently announced by CMS but is facing tremendous pushback from all quarters. “Healthcare discussions in the past have revolved around questions of coverage. I think the Medicare Part B demo will be a campaign issue…not the specifics of whether the add-on payment will be 2.5% or 4% or 6%, but what will be the government’s role in routine patient care.” In addition to the focus on reimbursement, Chen also expects questions around how academic medical centers will integrate with the current healthcare economy.

“When we look at payment changes, we keep looking for the sweet spot—on the policy side or clinically. All the efforts now with [accountable care organization] models and with bundling, it is to figure where the sweet spot is—right sizing the incentives for everyone in the system,” said Bjorklund. She stressed that the status quo just cannot be and that the government can play a significant role in the process.

Bjorklund has considerable faith in the promise of health information. “I think standardization of EHR [electronic health records] has been a long-sought goal…since the early 90s. We have, for some time now, heard suggestions for EHR to be converted into an open access system—to avoid vendor-capture of data and the other problems that we are currently facing with interoperability and to avoid silos.” She thinks that unlocking this data can have a lasting impact, especially with patient access to care and preventing duplication of testing.

Chen reverted to the statement by Bjorklund, saying that the bigger question is managing the status quo, “Should we defend it or change it? Should we accept that the right thing is to move away to the Part B demo? Also how does the Part B demo work together with the [Oncology Care Model]?

The government’s pledge to support personalized medicine efforts in healthcare, and the follow-up with vice president Joe Biden’s Cancer Moonshot program, were brought up by Fowler. “We need to think of whether we are adequately prepared for these initiatives, especially in the way we pay for all of this. I don’t think that a fixed price for Part B drugs is the way to go, and if we disagree with these proposals, this is the time to speak up,” she added. “We are moving toward a value-based world…all systems within healthcare are moving there, but this is based on FFS, which can cause the movement to collapse. We need to collectively tackle this systems-level issue.”

Chen highlighted the need for changes in regulation within healthcare. “We need to step back and evaluate the existing regulatory system in healthcare…roles played by the FDA, the CMS…there’s a lot of innovation all around, and regulation needs to keep pace to ensure this seamlessly translates into healthcare.”


 
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