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Evidence-Based Oncology Patient-Centered Oncology Care 2016

Panel Presents Unique Cost-Sharing Viewpoints in Oncology Care

Christina Mattina
Panelists from diverse vantage points in the cancer care landscape discussed the effects of cost sharing on patients in a discussion at the 5th annual Patient-Centered Oncology Care® meeting.
Watson routed the discussion back to the patient’s point of view, saying that patients newly diagnosed with cancer may not be ready to discuss cost and value—rather, they may be more concerned with their chances of survival. “In that case, a lot of the legwork and decisions about value-based care need to be made behind the scenes,” she said, so that when patients are presented with their options, they are not making decisions based on cost.

Instead, providers should ensure patients are aware of options like social workers and financial assistance programs, which, she believes, can reduce the patient’s stress earlier and improve their ability to manage costs down the line. Both Shrank and Klein agreed with the importance of having a robust case management system to help patients navigate the day-to-day challenges of oncology care. According to Klein, however, the lack of reimbursement for case management remains a challenge.

Shifting the conversation back to cost sharing, Klein talked about the need to educate policy makers that patients with serious illness should not be treated the same as a “regular patient,” where cost sharing is used as a tool to keep premiums low or to get patients to choose less expensive treatment options. Patients with cancer will not want to be asked questions about treatment choices, as they instead look to their healthcare provider to direct them to the best treatment.

Shrank agreed that current formularies are not constructed with the unique needs of cancer patients in mind. It may also be more difficult to quantitatively demonstrate to payers the effectiveness of eliminating cost sharing because the oncology medications are expensive and will not be able to prevent subsequent hospitalizations. Instead, payers are more likely to respond to the argument that eliminating cost sharing will result in better quality of care and improved patient experience.

To wrap up the panel discussion, Klein looked to the future, saying that those looking to overhaul the healthcare system need to “understand that not being thoughtful in the near term could leave a lot of people with challenges in terms of getting access to their treatment.” He encouraged providers, payers, and patients to work together to increase education and transparency, encourage a rational benefit system, and maintain critical safety nets.

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