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Narrow Networks in Cancer Care: Tough on Patients but Here to Stay

Mary Caffrey
Experts at the National Comprehensive Cancer Network Policy Summit discussed the present challenges of transitioning to alternative payment models at a time when the costs of many cancer therapies are rising.
Narrow networks, which limit where patients can receive care, are holding down costs, but the price to patients with cancer and providers in lack of convenience can be high, according to panelists who discussed changes in care delivery at the National Comprehensive Cancer Network’s (NCCN) June 25, 2018, policy summit in Washington, DC.

“The Evolving Healthcare Landscape: Implications for Access to Quality Cancer Care,” brought together leading oncologists, policy experts, and patient advocates to address the conundrum for today’s cancer patient: therapeutic advances mean there are more options than ever, but for many, barriers to the best treatments will be too high.

Joseph Alvarnas, MD, a hematologist/oncologist who serves as vice president for Government Affairs and senior medical director for Employer Strategy at City of Hope in California, said that unlike many other parts of the country, his state has lots of health plans—but that still doesn’t mean a patient will find adequate networks.

“The challenge here is if the motivation is to deliver low-cost care, [health plans] can find a low-cost provider in every market,” said Alvarnas, who is also the editor in chief of Evidence-Based Oncology. Narrow networks can work if there is a commitment to quality, but when price is the only priority, “their decisions are not based on, ‘Where do I get the best care?’ but ‘Where do I get the lowest price?’”

Narrow networks have proliferated under the Affordable Care Act (ACA) because of lower-cost plans sold on the marketplace. And in some cases, that’s left leading academic medical centers and NCCN member health systems on the sidelines, because their costs are considered too high. Alyssa Schatz, MSW, policy director for NCCN, presented research to the group showing that most cancer centers are in some exchange networks, and a few have not been placed in any exchange network.

It’s reached a point that the National Association of Insurance Commissioners, which creates policies and model legislation to bring some uniformity across state lines, needs to revisit the narrow network issue, said Jenny Carlson, associate vice president for Government Affairs at Ohio State University’s Wexler Medical Center.

John Cox, DO, a medical oncologist at UT Southwestern and Parkland Health and Hospital System, agreed that the ACA, while bringing coverage to many uninsured, has its drawbacks. “On the one side, I love that our patients have a secure insurance contract. They have access to care,” he said. But he’s seen examples of patients who must travel long distances, often carrying their medical records with them, to use the lone specialist approved by their plan. “It just puts up tons of barriers,” he said.

All this may be true, said Kavita Patel, MD, a senior fellow at the Brookings Institution, but no one should expect narrow networks to end any time soon. “Our narrow networks are an insurance company’s high-value network,” she said. They are considered a critical tool in controlling costs, so institutions that are left out must work with payers to show why they bring value and should be included.

Moderator Cliff Goodman, PhD, asked if oncologists and patients with cancer must live with narrow networks, what can be done to ensure that consumers are protected?

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