Will Absence of Certain Cancer Centers on Insurance Exchanges Impact Outcomes?

The Affordable Care Act (ACA) weaved-in several provisions to improve access to health insurance within the United States—Medicaid expansion, online exchanges, and allowing young adults (until 26 years) to remain on their parent’s plans, among others. However, narrow provider networks within these federal exchanges have raised questions about access to care. According to a new study conducted at The University of Texas, a majority of these exchanges do not include National Cancer Institute (NCI)-designated centers, which, the authors believe, might create a barrier for access to clinical trials and specialized care.¹

Studies have shown that federal exchanges either have narrow provider networks or, even if the regional provider network is broad, there are restrictions on certain categories of physicians or hospitals, which can also be a barrier for patients with complex care needs for disease such as cancer. While health plans are required to cover costs of participating in a clinical trial, they are not bound to do so for costs incurred out-of-network. Under these circumstances, absence of NCI-designated cancer centers from exchanges could prevent patients from receiving innovative treatments being developed in oncology.

For their study, the researchers extracted provider network data for the 2016 enrollment year, available as of December 2015. They characterized the networks that included Commission on Cancer (CoC)-accredited hospitals and NCI-designated cancer centers. Of the 4058 individual plans, network data were available for 3637 (90%) and hospital information on 3531 (87%). Of the 295 unique networks that were identified, 95% of networks included at least 1 CoC-accredited hospital, but only 41% included NCI-designated centers. The plan type was also a determinant of whether an NCI-designated center would be included in the network: 31% of health maintenance organizations and 49% of preferred provider organizations included them, independent of the metal level of an individual plan. As the authors expected, networks available in states and counties where the NCI-designated cancer centers were located were more likely to include the center, although only half of the networks included them.

The authors feel that their findings indicate lack of access to cancer care and reinforce the need to promote access to specialized care and clinical trials at community sites.

While the question about access might hold true, do accredited cancer centers really improve patient outcomes? Not according to a study that was published in 2014,² which found that while accredited cancer centers performed better on most process and patient experience measures but were worse on most outcome measures. So when policy makers consider improving access for patients enrolled on marketplace exchanges, they need to be aware of the differences in outcomes between the various sites of care.

References

1. Kehl KL, Liao KP, Krause TM, Giordano SH. Access to accredited cancer hospitals within federal exchange plans under the Affordable Care Act [published online January 9, 2017]. J Clin Oncol. doi: 10.1200/JCO.2016.69.9835.

2. Merkow RP, Chung JW, Paruch JL, Bentrem DJ, Bilimoria KY. Relationship between cancer center accreditation and performance on publicly reported quality measures. Ann Surg. 2014;259(6):1091-1097. doi: 10.1097/SLA.0000000000000542.