Key Takeaways from NCCN Summit on Value, Access, & Cost of Cancer Care

By Maureen Leddy, JD, Manager, Policy and Strategic Alliances, ACCC

On September 11, 2015, the National Comprehensive Cancer Network (NCCN) convened healthcare experts for a policy summit on “Value, Access, and Cost of Cancer Care.” ACCC policy staff was in attendance, along with a host of provider and patient organizations. The summit explored methods to achieve optimum cancer patient care while considering rising care costs, and NCCN’s work groups on Value, Access and Cost also reported their findings. Some key takeaways follow.

Views on Value

The discussion on value centered on appropriate measures for value from the patient, provider, and payer perspectives. Panelists generally agreed that a broader view of healthcare is necessary to assess value. This includes consideration of the continuum of care, rather than just a specific episode of care. The full cost burden of cancer care on patients must also be addressed, and may include employment, caregiver, and housing and transportation issues.

Access Issues

Panelists explored access issues, focusing on the growing demand for cancer care services and its impact on access. Health exchange plans were identified as a source of disparate care, in that enrollees choose plans based on cost and then, upon cancer diagnosis, are faced with inadequate provider networks and prescription drug coverage. The discussion also touched on recent legislation driving providers to value-based reimbursement, and projected impacts on patient access to academic cancer centers. For the employer-insured population, one panelist commented on a shift to contracts with specific hospitals for second opinion and potential treatment of specific malignancies.

Cost Control

Among potential methods for curbing costs, panelists cited caution in use of high-cost diagnostics, treatments and therapies; avoidance of hospitalizations and emergency room use; and increased emphasis on palliative and end-of-life care. The panel noted that savings in provider care costs are possible, particularly through increased care planning and patient navigator uptake.

In discussing the cost of anti-cancer therapies, panelists pointed out that oncology is unique in that there is currently maximum use of generics with little opportunity for shifting to lower-cost prescription drugs until the further introduction of biosimilars. While drug costs make up just 15% of cancer care costs, they represent the fastest rising cost in cancer care. The panel acknowledged the challenges to containing prescription drug costs, and noted that some pharmacy benefit managers (PBMs) are looking to employ an indication-based formula for drug pricing, reimbursing for drugs by value and differentiating claims by condition. In the context of biologics, greater approval and high usage rates of biosimilars will be important to cost containment in the coming years.

The policy team at ACCC will continue to engage in this discussion of rising cancer costs and challenges in patient access to care.

Continue the Conversation

Join ACCC in Portland, Oregon, Oct. 21-23, at the 32nd National Oncology Conference and continue the conversation in sessions that will explore issues of value, cost, and patient access to care including:

Patient Access and the Cost of Cancer Care Across Specialties
Peter B. Bach, MD, MAPP, Center for Health Policy and Outcomes,
Memorial Sloan Kettering Cancer Center

What Will It Take? Must-Haves for Alternative Payment Models
Erich Mounce, MSHA, The West Clinic, PC

Palliative Care Models: Solutions for Programs of All Sizes
Moderator: Michael Kolodziej, MD, FACP, Aetna; Amy J. Berman, BS, RN, The John A. Hartford Foundation;
Sibel Blau, MD, Northwest Medical Specialties; and Brad Smith, Aspire Health

The full conference agenda and registration information is available here.

 

Join the Conversation on Value in Cancer Care

by Amy O’Connor, Guest Blogger

In the last century, the scientific community has made enormous progress in the treatment and prevention of over 200 forms of cancer. Innovative treatments and medicines have led to truly meaningful headway for those with cancer, their loved ones, healthcare providers, and many others who have a stake in the fight.

To build on this progress, Lilly Oncology created PACE, which stands for Patient Access to Cancer Care Excellence. PACE gathers together a global network of advocacy groups, businesses, and individuals to support the healthcare decisions that will lead to new cancer cures and treatments. We encourage public policies that speed the development of new medicines, assure that cancer treatments respond to the needs and qualities of individual patients, and improve patient access to the most effective cancer medicines.

The cancer community faces the challenge of how best to make treatments affordable and accessible to patients, while ensuring that scientific innovation continues. Even with consensus on the need for high-quality, patient-centered care, viewpoints on what makes a cancer treatment valuable vary broadly among stakeholders.

With that in mind, we’re delighted to work with ACCC to bring the dialogue about value and quality in cancer care to center stage at ACCC’s upcoming National Conference. On April 1st, PACE member Jackie Doorhy will join representatives from the National Patient Advocate Foundation, Priority Health, and the Greater Baltimore Medical Center to discuss the value of cancer care and how to ensure high-quality care for people with cancer. But we don’t want to limit the conversation to the stage: we want you to get involved! From 11 am – 12 pm on April 1st, PACE will livestream the panel on our website. Join us by registering today!

By working together—through science, education, and advocacy—we can build the momentum that leads to new treatments and cures for cancer, today and in the future. We encourage you to become a part of the conversation on April 1st by registering for the livestream today and tweeting your questions to the panelists with @PACENetworkUSA and @ACCCBuzz.

Amy O’Connor is Director of Digital Government Affairs at Eli Lilly and Company.

Editor’s note: View previous ACCC Town Hall discussions here.