During this segment, the panelists share insights about clinical practice guidelines such as those released by the National Comprehensive Cancer Network (NCCN) and Centers for Medicare & Medicaid Services (CMS) and discuss their impact on managed care.
The panelists explain that as organizations such as the NCCN and CMS continue to enforce stricter requirements with more paper work than previously, when payers try to adjudicate the quality of the evidence and look to a panel of experts to help them negotiate expenses, it impacts managed care.
Michael Kolodziej, MD, suggests that currently the payers are the gatekeepers when managing this information. However, a shift to providers becoming the gatekeepers is under way.
Jeffrey Weber, MD, PhD, is concerned that this shift will burden providers. However, Dr Kolodziej and Daniel J. George, MD, disagree, and explain that the forms that are required to be filled out are simple and brief.
Dr George explains that the burden occurs when coverage for expensive cancer immunotherapy agents is denied. At this point, a peer-to-peer process is requested, in which a healthcare professional discusses the case with another healthcare professional. The peer-to-peer process includes additional reviews and takes a considerable amount of time.
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen