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Financial Toxicities Reshape Utilization of Novel Cancer Treatments and ASCO, Payers, COA React to Oncology Care Model


IP Blog | Dave Melin | April 26, 2015

BioBlog Weekly oncologyThis week in health care, a deeper look at the financial toxicity of cancer treatment and ASCO, Payers, and COA share their thoughts on CMS’s new Oncology Care Model.

Financial Toxicity Must Become Part of the Conversation

This article takes a hard look at the emerging phenomenon of “financial toxicity”, a term that is “gaining traction in cancer circles and making its way into mainstream vernacular as a means of equating the effect of out-of-pocket expenses with the adverse physical effects of cancer care – things like nausea, vomiting and hair loss.” In a recent survey of 480 current and former cancer patients, “37.1 percent of our respondents overall and 58.8 percent of patients ages 18-44 reported being seriously or very seriously concerned about bankrupting their families.”

ASCO, Payers, and COA React to CMMI’s New Oncology Care Model

Early this year, CMS announced the rollout of its new Oncology Care Model (OCM), which is designed to incorporate “financial and performance accountability for episodes of care (EOC) with regards to chemotherapy administration to patients with cancer.” In this article, experts react to the new OCM, with opinions ranging from “applause” to “concern”.

CMS Proposes Modest Increase to 2016 Hospital Inpatient Payments

In a draft payment formula proposal released by CMS, the agency proposed payment system tweaks that altogether would amount to “the overall payment would increase a modest 1.1 percent,” which is less than the American Hospital Association’s (AHA) goal of a 3.2 percent increase.

USPSTF Breast Cancer Screening Recommendations Would Cost Thousands of Lives and Could Eliminate Mammography Insurance Coverage for Millions of Women

Following the publication of much more conservative breast cancer screening recommendations by the U.S. Preventative Services Task Force (USPSTF) last week, the American College of Radiology has come out strongly against the recommendations, arguing that adoption “would result in thousands of additional and unnecessary breast cancer deaths each year” and “could also strip millions of women 40-and-older of private insurance coverage with no copay for mammograms at the time of their choosing previously guaranteed by the Affordable Care Act (ACA).”

Cancer Hospitals Participating in at Least Some Exchange Plan Networks

A new study from Avalere Health has found that most cancer hospitals participate in some form of exchange network: “while 75% of cancer hospitals have some exchange plan contracts, that still left 25% with practically no network coverage among exchange plans.”

Medicaid Plans’ Rx Carve-ins Save 14.6% Carve-outs, Study Finds

A recent study done by the America’s Health Insurance Plans (AHIP) group has found that “Pharmaceutical costs in Medicaid managed care programs that “carve in” pharmacy benefit management and thus let insurers handle it are 14.6% lower in terms of average net cost per prescription than in “carve-out” Medicaid states.”

Healthcare Spending Experiences a Growth Spurt

A recently released report has found that “spending grew 6.6 percent between February 2014 and last February, one of the highest growth rates reported in years.” While still slow, analysts note that there is a corresponding uptick in hospital job growth and are hopeful that the slight acceleration will continue.

Value-Based Decision Making at the Bedside

In a recent panel held at the annual NCCN meeting, cancer care experts discussed how they interact with the NCCN Guidelines and what to do to ensure quality care in the space outside the guidelines.

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