Policy

The cost of oncology care has increased significantly in recent years, leading employers to worry about how they can provide consistent benefits for employees with cancer and their family members, according to Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition.

This article explores elements of patient and consumer engagement implicated by Medicare’s alternative payment models, emphasizing the potential for shopping and use of cost information.

While colorectal cancer screening rates have seen a recent progress toward achieving the Healthy People 2020 objectives, breast cancer screening rates have remained static, and cervical cancer screening rates have been declining.

Precision medicine has demonstrated clinical utility and cost-effectiveness, which is why many believe this approach will be key to value-based cancer care in the future, said Jonathan Hirsch, founder and president of Syapse.

Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology, admits that he was once “oblivious” to his patients’ concerns about the cost of cancer treatment. However, it is important for clinicians to empathize with these fears and understand how they can factor into a patient’s care choices.

The transition to value-based care has been helpful in getting providers to examine their own performance and find ways to improve quality, said Andrei Gonzales, director of value-based reimbursement initiatives at McKesson Health Solutions.

Patient-centered medical homes are valuable because they allow insurers to look at the cost of all of the patient’s treatments, services, and physicians throughout the continuum of care, explained Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ.

A study published last October indicated that hospitalist groups with a higher ratio of physician assistants to physicians achieved the same outcomes at lower cost in a community hospital setting. Lead author Timothy Capstack, MD, explained to The American Journal of Managed Care® how these hospitalist models can benefit patients in a variety of healthcare settings.

Underinsurance, which occurs when people have insurance but aren't covered for services they need, is a serious problem in the US, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan. He proposed some strategies to alleviate this phenomenon, like smarter deductibles and revised Internal Revenue Service (IRS) rules.

For cost-effective cures, the drug pricing policy challenge is not simply to lower prices, but also to spread the drug costs among payers.

Bundled payment models could provide surgeons with a full spectrum of data that can help them decide which hospital is the right choice for their patients, said Andrei Gonzales, MD, McKesson's director of value-based reimbursement initiatives. He also said that this data can drive improvement for hospitals that may be falling behind.

Payers have been slow to adopt new technologies, but they are starting to be more proactive in seeking out genomic profiling companies, according to David Fabrizio, of Foundation Medicine, Inc. These molecular diagnostic tools make the healthcare process more efficient by performing a comprehensive test at the point of diagnosis.

Shortly after Cigna announced it would stop covering the name-brand EpiPen, CVS declared it would begin selling a cheaper generic version of the costly epinephrine injector. Earlier in the week, Heather Bresch, CEO of EpiPen manufacturer Mylan, had reflected on the controversy surrounding the device’s price.

Payments for catastrophic coverage under Medicare Part D have more than tripled since 2010, rising past $33 billion in 2015, according to a new report from the Office of Inspector General (OIG). The report identified high-priced specialty drugs as a major driver of the increase in spending.

While rapid innovations in the field of oncology have improved treatments, the magnitude and dimension of clinical benefits vary widely.

Cancer care and its associated costs can combine with everyday bills to create a significant financial burden, especially for young adults with cancer, said Samantha Watson, founder and CEO of The Samfund.

The kind of data oncologists need to move towards value-based care isn’t easily accessible in patient electronic health records, but new platforms like Cancer Outcomes Tracking and Analysis (COTA) are trying to make it easier, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Among Michigan primary care practices, sustained participation in a pay-for-value program appears to contribute to improved utilization outcomes for high-need patients.

This year, the most read articles from The American Journal of Accountable Care® explored how healthcare providers and payers have implemented innovative ideas to reduce spending while maintaining or increasing the quality of care.

A case study of an innovative model for wound care suggested that an integrated approach to healing wounds could result in decreased costs of care and length of hospital stay.

A recent study that conducted interviews with mainly Latino residents of agricultural communities in California found that most considered affordability, not access, a major barrier to buying healthy foods.

The new era of data informatics tools can help providers and payers understand the tiers of risk that determine the economics of care delivery, which is crucial to value-based cancer treatment, according to Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology

What we’re reading, December 16, 2016: consumers now have until December 19 to enroll in a marketplace plan for coverage starting on January 1; 20 states file lawsuit against 6 pharmaceutical companies alleging generic price fixing; women who were tested for the BRCA mutation gene after Angelina Jolie’s announcement may not have been at high risk to begin with.

The authors illustrate a methodology for delineating variations in medical costs for patients with similar clinical conditions and needs using electronic health record data.

As the healthcare industry continues its transition toward value-based care, some medical ethicists have raised concerns about how education with an emphasis on value can potentially conflict with patients’ best interests. An opinion letter published in JAMA discusses various strategies for addressing these tensions.