Oncology

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.

Reality seems so simple. We just open our eyes and there it is. But that doesn’t mean it is simple. Penn and Teller

As costs for cancer care continue to rise, Pontchartrain Cancer Center does benefit and cost analyses for all patients before they start therapy and also takes into account any social needs they might have, said Kathy W. Oubre, MS, chief operating officer at Pontchartrain Cancer Center.

By communicating with oncologists, Flatiron enhances their understanding of potential issues in clinics and how technology can enhance clinical workflow, said Bobby Green, MD, chief medical officer at Flatiron.

Tesh Khullar, senior vice president & advisor, Flatiron Health, explains what efforts are needed to make sure providers are comfortable prescribing biosimilars.

We learn most when we have benchmarking and we can examine our own processes of care, explained Michael Kolodziej, MD, vice president and chief innovation officer at ADVI Health, Inc.

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.

AJMC®TV interviews let you catch up on what’s new and important about changes in healthcare, with insights from key decision makers—from the clinician, to the health plan leader, to the regulator.

Managed care and clinical updates in cancer treatment.

Speakers from major area cancer centers and Independence Blue Cross addressed progress in implementing value-based care initiatives during a session held September 19, 2019.

Speakers at the September 12, 2019, Policy Summit of the National Comprehensive Cancer Center, held in Washington, DC, addressed what practices have learned from experience with the Oncology Care Model and what steps must occur to standardize patient reported outcomes to incorporate them into reporting.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

This week, the top managed care news included a new guide that balances curbs on opioid abuse with the needs of patients with chronic pain; HHS proposed reforming antikickback rules to help boost value-based care; a report found flaws with Medicaid work requirements.

In a commentary adapted from the organization's official response to CMS' proposal, the author highlights potential challenges that proposed alternative payment model presents for members of the American Society for Radiation Oncology (ASTRO).

Although results of other recent studies have noted the rise in the rate of obesity-related cancers among younger adults, this is the first study to also find a concurrent decrease in the rate of new cancer cases among patients 65 years and older.