AJMC Oncology Conference Helps Managed Care Stakeholders Do More for Patients Who Have Coverage, But Still Have Limits

Published on: 

At its third annual conference, Patient-Centered Oncology Care 2014, The American Journal of Managed Care addressed new challenges in cancer care: more patients have coverage, but they may be "underinsured" or barred from academic centers. Amid rising drug costs and regulations that threaten community practices, the head of the largest oncology organization outlined a path toward value-based reimbursement.

AJMC Oncology Conference Helps Managed Care Stakeholders Do More for Patients Who Have Coverage, But Still Have Limits


BALTIMORE, MD. — Cancer care in America is at a crossroads, for while patients are gaining control over their care in some ways, they are losing choices, too, including where some can get treatment. Those were among the lessons from Patient Centered Oncology Care 2014, the annual conference sponsored by The American Journal of Managed Care, which brings together payers, providers, policymakers, and leaders from the pharmaceutical industry.

Approximately 200 attendees from across the managed care spectrum attended the meeting at the Marriott Waterfront in downtown Baltimore November 13-14. Highlights included keynote addresses November 14 by Peter Yu, MD, president of the American Society of Clinical Oncology (ASCO), and Burton VanderLaan, MD, medical director of Priority Health. Among the key lessons from Dr VanderLaan:

  • While the ranks of uninsured shrink, the payer mix is changing as more consumers shift to the individual market, Medicare and Medicaid. This has implications for commercial insurers. “It’s much easier for an individual to go change coverage than for a large employer to move 5000 employees.”

  • In cancer care especially, the problem of dealing with the uninsured may shift to the problem of the “underinsured.” This refers to patients who select low-premium plans that result in high deductibles and out-of-pocket costs. Already, both patients and oncologists are learning that narrow networks in some exchange plans under the Affordable Care Act do not cover care at academic cancer centers.

In his address, Dr Yu said the cost of cancer care in the United States, and the need to listen to what cancer patients want is not only transforming the way Americans deal with health insurers, but also the way physicians practice medicine.

The changing value proposition is causing oncologists to ask, “What does it mean to be a doctor in the United States?” he said. Physicians can no longer be someone who does things to patients, but must be someone who does things with patients. The cancer patient must be part of the decision-making, because the implications of care have changed so much.

Dr Yu later offered principles for a value-based payment reform initiative that ASCO is discussing with Congress, in an effort to address high costs and misaligned incentives that are not always in the best interests of patients or practices.

Ted Okon, executive director of the Community Oncology Association, warned that without payment reform and changes to the 340B program, community oncology practices are endangered, and efforts to keep cancer patients out of the hospital will be a moot point.

Palliative care. The conference opened November 13 with a session on palliative care. When is it appropriate? What the barriers to broader use? How can payers start the discussion with doctors and patients?

Marian Grant, RN, of the University of Maryland, said many patients confuse the broader realm of palliative care—which involves treatment for symptom and pain relief and spiritual needs—with hospice, which is limited to patients with a life expectancy of less than six months. Grant cited a study of lung cancer patients that showed early use of palliative care extended life by three months.

The evening’s highlight was a talk from Amy Berman, RN, who has lived four years with stage 4 inflammatory breast cancer. By pursuing palliative care—and not more aggressive surgical options, she has traveled the world and estimates she has saved her insurer $1 million. “I made choices that were logical choices, but not choices that most people make or even discuss,” Berman said.

About the Journal

The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. Other titles are The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision makers with information to improve the efficiency and health outcomes in managing pharmaceutical care. In December 2013, AJMC introduced The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

CONTACT: Mary Caffrey (609) 716-7777 x 144