Staying Focused on the Cancer Patient, Amid Rising Drug Costs and New Payment Models

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Giving cancer patients what they want and need is the goal, but getting there isn't easy, according to healthcare experts who took part in Patient-Centered Oncology Care 2015, presented November 19-20, 2015, by The American Journal of Managed Care. Drug costs demand difficult conversations about value, and changes in the law require oncologists to learn whole new ways to be paid.


BALTIMORE, Md.—Stakeholders from across healthcare met here November 19-20 to discuss the challenges of rising drug costs, new payment models, and staying on top of innovation—all while keeping the focus on cancer patients, who are under more financial stress than ever.

Understanding both the big picture—what high drug costs mean to society—and the small—how costs affect the individual patient—was a theme throughout Patient-Centered Oncology Care 2015, the fourth installment of the multi-stakeholder meeting presented each year by The American Journal of Managed Care. The meeting took place at the Baltimore Marriott Waterfront.

Designed to bring together payers, providers, policymakers, leading researchers from academia, the pharmaceutical industry, and patient advocates, the meeting gives healthcare experts from different realms an opportunity to hear perspectives from others they might not encounter at professional meetings. “Each year we strive to not only address the most current topics in cancer care delivery, but we also bring together those leaders who understand where we are headed,” said Brian Haug, president of The American Journal of Managed Care.

Keynote speaker Julie Vose, MD, MBA, FASCO, president of the American Society of Clinical Oncology (ASCO), discussed how the demise of the Sustainable Growth Rate (SGR) is a welcome event, but oncologists must prepare for the Merit-Based Incentive Payment System (MIPS), a result of the Medicare Authorization and CHIP Reauthorization Act, or MACRA. “Although the SGR is gone, we are still cutting up one pie. The size of positive updates or bonuses depends on how many people get penalties for not performing. This is new. And scary,” Vose said.


The drive to measure quality is a good thing, she said, but there is a downside. “Unfortunately, there is an administrative burden that physicians have to bear, and so there’s not much time to spend with the patient,” she said, adding, “We have to take this back to the patient, and physicians need to ensure that they don’t just turn into data-entry operators.”

Vose and others discussed the financial pressures on community oncology practices, many of which have folded or consolidated in recent years. During a panel discussion, Ted Okon, MBA, executive director of the Community Oncology Alliance, called for reform of the 340B program, which was designed for safety net hospitals but has exploded beyond that purpose.

Pressure on patients. Despite administrative pressures, rising cancer drug costs make conservations with patients about their goals and values more important than ever, experts said. A panel discussion among Peter Bach, MD, MAPP, of Memorial Sloan Kettering Cancer Center; John Fox, MD, MHA, of Priority Health; S. Yousuf Zafar, MD, MHS, of Duke Cancer Institute, and Dan Klein of the Patient Access Network Foundation explored the tough calls that doctors and patients must make, as very expensive therapies may offer only a few extra weeks of life, while leaving families with huge debts. Bach was among the first physicians to bring the issue of cancer drug costs into the public arena; today, drug prices are a topic in the presidential race. “Oncology is the only sector where the manufacturers set their own price,” Bach said.

Joseph Alvarnas, MD, a hematologist-oncologist at City of Hope, and the editor-in-chief of Evidence-Based Oncology, said innovation has given physicians the ability to treat some cancers where few options existed. Multiple myeloma, for example, has seen an explosion of new therapies after a 40-year dearth of discovery. But as Stacey McCullough, PharmD, of Tennessee Oncology pointed out, innovation only helps if patients take the medication.

Oral chemotherapy may seem better for the patient because it’s more convenient, “but they are also tasked with the responsibility of managing their own care. There’s a correlation with how much medication the patient takes and their outcome.” Adherence rates with oral chemotherapy are only 63 percent, she said.

Shifting Risk. For all the advances in cancer drug therapy, several experts said the bigger change may be in payment reform: CMS’ goals for value-based care will require physicians to start assuming risk, and this may alter decision-making in cancer care. For starters, “Physicians rarely talked about costs, but as risk is shifting to us, we’re having those conversations,” Alvarnas said.

Payers on hand asked whether the shift in risk would bring more focus on palliative care, and whether there should be standards for disclosure. “Would you want to know that your oncologist is at risk for your cancer care?” asked Burton VanderLaan, MD, FACP, of Priority Health.

So far, some changes aren’t as dramatic as advertised, said Kavita Patel, MD, MSHS, of the Brookings Institution. Accountable care organizations (ACOs) she said, “are just dressed up fee for service.”

About the Journals and

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include 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, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings 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: Nicole Beagin (609) 716-7777 x 131