Oncology

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included research that may hold the key to slowing progression of multiple sclerosis; Humana says it is saving billions of dollars through value-based care; the challenges of rural healthcare delivery.

Here are the top 5 articles for the month of November.

Here are 5 interesting findings from the November 2019 issue of AJMC®.

After a request for additional input from oncologists, practice administrators, payer representatives, and experts in physician payment and business analysis, ASCO has issued updated guidance on PCOP. With CMS’ Oncology Care Model set to end in 2021, the current draft of ASCO’s Community-based Oncology Medical Home model would be an option to take its place.

The biggest advice I would give to practices and care teams trying to really engage patients more is be innovative, explained James Hamrick, MD, senior medical director at Flatiron Health.

GRAIL has generated enormous innovations in oncology care over the past 2 decades and will continue this trend through exploring 1 of oncology’s biggest opportunities, early detection of cancer, said Joshua Ofman, MD, chief of Corporate Strategy and External Affairs at GRAIL Inc.

A House committee approves a bill to ban all flavored tobacco products; anal cancer rates are on the rise; the debate continues over competing healthcare measures.

Nina Chavez, MBA, FACMPE, chief operating officer, New Mexico Oncology Hematology Consultants, Ltd., discusses if she thinks biosimilars will play a role in lowering costs in coming years.

James Hamrick, MD, senior medical director at Flatiron Health, discusses some of the biggest challenges with trying to understand what constitutes value for patients and then turning that into actionable information.

Providing providers with relevant data on quality of care and profitability allows them to adjust their practices efficiently, said Erich Mounce, chief operating officer, OneOncology.

Most patients receiving multimodality cancer care receive care from different practices. Therefore, episode-based payments in oncology must hold multiple providers accountable for costs and quality.

Former FDA Commissioner Scott Gottlieb, MD, who has returned to the American Enterprise Institute, left FDA in April after 2 whirlwind years that saw a record pace of approvals and policy actions that covered everything from high drug prices to teen vaping. He spoke Friday in Philadelphia at Patient-Centered Oncology Care®, the annual meeting of oncology reimbursement stakeholders held by The American Journal of Managed Care®.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Consolidating unified interests for improved cancer care can enhance efficiency and quality of care for patients, said Tracy Bahl, MBA, president and chief executive officer of OneOncology.

This week, the top managed care news included CMS started planning for life after the Oncology Care Model; a judge blocked a rule requiring immigrants to have health coverage; Election Day brought news for Medicaid work rules.

Oncology care groups have praised the multipayer Oncology Care Model (OCM) for transforming cancer care through greater focus on care navigation, palliative care, survivorship, and keeping patients out of the emergency department. But there are complaints that practices can be penalized for elements beyond their control—notably, the soaring cost of state-of-the-art immunotherapies that were not on the market when the OCM was conceived.

By continuing to gather data on specific genomic data and profiles, we can heighten knowledge of applied treatment information on patient conditions, said Bobby Green, MD, chief medical officer at Flatiron.

Lawrence N. Shulman, MD, director of the Center for Global Cancer Medicine at the Abramson Cancer Center, and professor of Medicine at the Hospital of the University of Pennsylvania, discusses how value-based care can advance the quality of oncology care that it isn't currently.

I think there is a lot of confusion, especially in the patient community, about clinical research., explained Bradley Prechtl, MBA, chief executive officer of Florida Cancer Specialists and the American Oncology Network.

Referencing patients as attributable examples of necessary care has assisted in developing strategies for pharmacy and medication benefits, said Jeremy Whalen, PharmD, BCOP, Specialty Clinical Program Director for Oncology at Prime Therapeutics.

Proposed changes to the Stark Law that would make collaboration easier have purposely excluded pharmaceutical manufacturers, according to speakers at the Community Oncology Alliance Payer Exchange Summit.

The Oncology Care Model is a leading innovation in the move from fee-for-service to value-based reimbursement in large part because CMS has made adjustments based on physician feedback, according to an agency official who addressed the Community Oncology Alliance Payer Exchange Summit.

What would a successor to the Oncology Care Model (OCM) look like? Community oncologists discuss at the Payer Exchange Summit sponsored by the Community Oncology Alliance.

Even without input from the Oncology Care Model, community practices can measure performance data through a robust electronic medical record like Flatiron, said Erich Mounce, chief operating officer, OneOncology.