Oncology

Coping with advanced cancer, Bev Veals was in the hospital for chemo this summer when she got a call that her health plan was shutting down. Then, the substitute insurance she was offered wanted her to pay up to $3,125, on top of premiums.

Healthcare reform will bring new payment models and new power for consumers, and cancer care delivery will not be immune. With that in mind, The American Journal of Managed Care will bring together experts from the front lines to Baltimore, Maryland, November 14-15 for a conference to share how the goals of better care, savings and fair compensation can be achieved, even in the world of oncology.

A new study from The American Journal of Pharmacy Benefits finds that physicians who treat cancer patients may be influenced by the reimbursement policies of the Medicare claim processors that pay them.

Adhering to the best practices in cancer care may be the answer many oncologists have been looking for, at least according to one hospital's findings.

Bruce Feinberg, DO, Vice President and Chief Medical Officer, Cardinal Health Specialty Solutions, says cancer treatment is more than clinical guidelines, protocols, or individual drugs.

The federal sequester trims Medicare payments for cancer patients receiving chemotherapy in doctors' offices in an effort to save the government money. Instead, it will end up costing more in the long run, according to the president of the American Society of Clinical Oncology (ASCO).

Although researchers have made powerful new targeted treatment options available to oncologists who treat breast cancer patients, options such as pertuzumab are associated with high costs which raises questions about access as payers assess the value of treatment.

Expert panel convened by the American Journal of Managed Care provides insight into the challenges faced by clinicians and payers when administering cutting-edge cancer medications.

Since the rise of genetics and advanced molecular biology, cancer research is a field that has become almost as obsessed with understanding aberrant metabolism as it is with devising therapies.

In order to deliver quality and cost-effective cancer care, Michael Kolodziej, MD, Aetna's national medical director for oncology strategies, says that providers need to get better connected with payers.

Methods for better identifying malignant versus benign disease before nephrectomy could provide significant benefits to patients and payers.

In an effort to offset cost increases associated with the Affordable Care Act (ACA), the Obama administration intends to expand hospitals' access of the 340B discount drug plan. While the expansion may sound promising to some, many others worry that the program will threaten the quality of care, as increased participation risks higher potential for abuse. Even worse, the 340B program will likely rise the cost of cancer care.

For patients with early-stage lung adenocarcinomas, the histological pattern of the tumor predicts the risk of recurrence and might help guide surgical decisions.

Oncologists have a reputation to maintain - and according to the latest report from ZS Associates, when it comes to fortifying against pharmaceutical sales representatives, the specialty remains characteristically hardboiled for the second year in a row.

For the first time, government advisers are recommending screening for lung cancer, saying certain current and former heavy smokers should get annual scans to cut their chances of dying of the disease.

Panelists agreed that the cost of the new agents discussed to treat melanoma will be a challenge, just as the cost of healthcare as a whole in the United States is a major challenge.

Dr Fendrick asked panelists what they think about the idea of centers of excellence for specific cancers and an evidence-based steerage.

It's very, very complex to try to envision how you would come up with a single payment for an episode and not have a thousand different types of episodes in order to capture the heterogeneity of these diseases and the cost, said Dr Malin when asked to discuss the bundled payment method in oncology.

In this portion of the panel discussion, Dr Fendrick asked the panel whether or not they have noticed cost-related lack of access or nonadherence with the new agents being discussed.