Payers

The development and access to orphan indications rely on reimbursement models that require regulatory action toward out-of-pocket costs for patients, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

In the next 5 to 10 years, providers and health systems need to be thinking about how all the pieces of a new system that delivers holistic, value-based care fit together, said Will Shrank, MD, chief medical officer, Humana, during the opening plenary at the National Association of ACOs fall meeting.

As minimal residual disease (MRD) and other measures to detect cancer burden are increasingly used to predict outcomes and direct future treatment decisions, Amgen has chosen to partner with Adaptive Biotechnologies to use the clonoSEQ product to assess MRD across multiple drug development programs.

Unsustainable healthcare costs are driving seismic changes to the way payers do business and are requiring the ability to extract deeper insights from data assets.

As 2020 Medicare Advantage (MA) premiums will decline 14.0% from 2019, beneficiaries will have access to greater benefits, which has contributed to enrollment continuing to grow year over year, according to CMS.

While the number of employers who reported they had self-insured at least one health plan had increased from 1999 to 2016, there was a sharp decrease by 38.7% in 2018, according to research from the Employee Benefit Research Institute.

CMS is trying to make a 2-sided risk model in the Oncology Care Model enticing for practices, but there is still a lot of math practices need to work out before making the decision, said Blase Polite, MD, associate professor of medicine and the executive director for accountable care at the University of Chicago.

Novel therapies come with high costs, but they have the potential to more effectively treat some patients, and employers are struggling to handle the cost burden of them, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Providing access to complex therapies through the Medicare market can benefit patients who are disproportionately ignored by socioeconomic status, said Scott Gottlieb, MD, former FDA commissioner (2017-2019).

Getting Americans in rural areas the right care at the right time is an issue that must be tackled at all levels. Ongoing efforts to coordinate care management and resources can prove beneficial for the rural communities that need it most.

CMS' new radiation oncology payment model is slated to begin on January 1, 2020, but the significant billing changes that the model requires will require more time.

Oncologists may be able to use circulating tumor DNA (ctDNA) to guide treatment decisions and predict which patients will have disease recurrence, according to 2 studies in JAMA Oncology.

To make headroom for expensive, potentially curative therapies in the pipeline, the healthcare needs to remove ineffective care from the system, said Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy.

Despite growing interest in addressing social determinants of health and recent research into interventions that address food insecurity, there are only a small number of low-quality studies in the area.

Healthcare does not necessarily need to be disrupted, but it does need to evolve and utilize technology so that cancer care can move beyond the conventional walls of the healthcare delivery system, said Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy, during her keynote speech at the Quality Cancer Care Alliance’s Leadership Summit.

As orphan drugs account for an increasing share of drugs approved, they are driving up the cost of drug launches and drug prices. In a new paper, America's Health Insurance Plans analyzes these rising costs and the use of orphan drugs and asserts that policy makers need to revisit the Orphan Drug Act.

Following the release of the latest accountable care organization (ACO) participation numbers from the CMS, the National Association of ACOs (NAACOS) authored its own take on the latest data around the Medicare Shared Savings Program, Medicare’s largest and most prominent value-based payment program serving 11 million patients.

Maria Trojano, MD, professor of neurology at the University of Bari, Italy, offered the opening lecture at ECTRIMS 2019, the 35th Annual Congress of the European Committee for Treatment and Research in Multiple Sclerosis, taking place in Stockholm, Sweden.

Employers have become more aware of how key an issue mental health is for employees and they are relieving some of the perceived stigma by making it okay to talk about mental health issues, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

There are less surprises in the results for performance period 4 of the Oncology Care Model, and practices seem to be mostly happier with how they’ve done, said Mike Fazio, senior vice president of client services, Archway Health.

An Expanded Treatment Protocol study that provided expanded access of the FDA-approved ruxolitinib, which treats polycythemia vera (PV) in patients who are intolerant or resistant to hydoxyurea, affirmed the safety and efficacy findings of the trials used for approval.

Currently, employers choose health plans based on administrative costs and provider discounts, but they need to start engaging around value-based reimbursement, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Out-of-network billing continues to become more common for patients with private insurance even when seeking treatment at in-network hospitals, which creates a financial strain for many patients, according to study results published by JAMA Internal Medicine.

Patients with complex needs may need more complex solutions to manage their health issues. Innovations in technology and integration of data have made it possible to improve patient interactions with the pharmacy to better manage their diseases. The American Journal of Managed Care® recently spoke with Christine Sawicki, senior director, specialty product development and innovation, CVS Health, about the impact new technology can have on patient experience, health outcomes, and drug spending.

The cost of radiation oncology services has typically been a small part of the Medicare and Medicaid budget, but with more patients having complex radiation treatments, it is becoming more important to have alternative payment models in the space, said Shalom Kalnicki, MD, FASTRO, FACRO, professor and chairman, radiation oncology, Montefiore Einstein Center for Cancer Care and Albert Einstein College of Medicine.