Insurance Hurdles Cause Delays and Detours in Cancer Care: Coral Omene, MD, PhD

In value-based cancer care, insurance hurdles can create administrative burdens that cause anxiety for patients and providers and delay essential treatments or divert from optimal patient care, said Coral Omene, MD, PhD, associate professor, Rutgers Cancer Institute and RWJBarnabas Health.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What do you think are the most significant shortcomings of current insurance and payment policies that hinder the delivery of value-based oncology care?

One of the hurdles that we face in oncology is, when we're trying to deliver quality care based on evidence-based guidelines, we sometimes have to go through several hoops and steps to get these drugs that should be approved for these patients to deliver what may be potentially the drugs with the best survival for your disease at that point in time.

Sometimes we have to go through so many steps and appeals processes because the guidelines or the algorithms used may be somewhat different based on what the insurance companies may be using for their own delivery of care. I find that to be very, very taxing on not only the patients, but the providers and the health care system as a whole. The patients are anxious, [and] we are anxious and frustrated because we want to deliver care, but we have to go through so many steps in place.

How long can that appeals process take?

It varies, obviously, but it can be several days, and it can actually go up to over a week or 2. And that can be tough. If someone has an aggressive disease that you need to start treatment right away, they don't have a week, a week-and-a-half to get this [treatment approved]. Sometimes what will happen is one might have to abandon that plan and go to the next thing, which may be okay but may not be what is indicated as the best option as first-line treatment, for instance. Sometimes, depending on the insurance company, depending on the appeals process and how long it takes to set that up, you might have actually lengthy wait times.