Special Issue: Payer/Provider Relationships in Oncology

It is not just 1 physician who cares for a patient enrolled onto a clinical trial but rather a complex system of several physician teams, sometimes with very different opinions, who must work together for therapy to be successful and for the patient to have faith in his treating team.

The oncology patient“centered medical home is a physician-driven, patient-focused value proposition that can make a difference for patients, oncologists, and the cost of healthcare.

Higher use of performance-based payment mechanisms and capitated arrangements is associated with a decrease in the amount of time physicians spend with patients with cancer.

Out-of-pocket payments differ widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient out-of-pocket cost will be critical in informing choices.

In a safety-net hospital, patients with Medicaid have rates of advanced-stage cancer similar to those patients with other types of insurance; however, patients with no insurance have significantly higher rates of advanced disease.

To improve formulary design processes and support payers in providing more effective healthcare, policy makers should consider involving commercial payers in the development of comparative effectiveness research and creation of research and treatment guidelines.

Comparative effectiveness research and pragmatic clinical trials are valued methods to address the limitations of traditional randomized trials, answer questions of cost-effectiveness or noninferiority, and inform data-driven dialogue and decision making by stakeholders.

As physicians enter a new world of therapies for molecularly defined lung cancer, it will be critical for hospitals, drug companies, and insurance companies to work out the interplay of molecular testing and coverage for expensive therapies that are effective but only in smaller, defined groups of patients.

The Wilshire Oncology Medical Group developed a medical oncology home pilot to offer a transparent, high-quality, high-value cancer program in partnership with its largest California health plan, Anthem Blue Cross WellPoint.

Journal of Oncology Practice (JOP) and The American Journal of Managed Care (AJMC) join efforts to highlight work focusing on issues affecting payers and providers.