ACCC’s recent 31st National Oncology Conference featured 45-minute “think tanks,” supported by a grant from Genentech, on four hot topics in oncology. This is the second in a four-part ACCCBuzz blog series recapping these discussions from Think Tank facilitator, Joseph Kim, MD, MPH, of MCM Education.
By Joseph Kim, MD, MPH, Guest Blogger
At the recent 2014 ACCC National Oncology Conference, a Think Tank focused on the healthcare marketplace was held to discuss how recent changes have impacted oncology care. Since the Affordable Care Act (ACA) was signed into law on March 23, 2010, the evolving market forces have driven community cancer centers, hospitals, and oncology providers to focus more on affordability, access, quality, and accountability. The ACA has made it possible for millions of Americans to purchase health insurance through new employer requirements, the Health Insurance Marketplace, and the expansion of public programs like Medicaid.
- In 2014, it is estimated that up to 32 million people will receive health insurance coverage through the ACA.
- More than 8 million have selected a marketplace plan since enrollment began in October 1, 2013.
- Adults lacking health insurance was 18% in the third quarter of 2013 and dropped to 13.4% in May of 2014.
Growing Need for Patient Navigation
The oncology community continues to face tremendous pressures and challenges as new patients enter the system. Many first-time insurance purchasers need assistance navigating the process of signing up for healthcare coverage and they remain confused about newly encountered terms like deductible, co-pay, co-insurance, and out-of-pocket maximum. As cancer patients evaluate treatment options and the total cost for treatment, some will enroll in patient assistance programs while others will lean heavily on family members for financial support. Although some cancer programs are staffed adequately to educate and counsel patients through this process, others are struggling to fill these critical positions as they anticipate a rapid influx of new patients. ACCC has developed a set of resources around cancer patient navigation and patient assistance programs, as well as the Financial Advocacy Network with resources for both clinicians and administrators.
Pharmaceutical patient assistance programs continue to be a valuable resource for cancer patients who are being treated by expensive new therapies. Medicare lists most of the programs by drug name.
The Patient Access Network Foundation (or PAN Foundation) is another helpful resource that also provides information about co-pay assistance programs.
New Patients Remain Functionally Uninsured
Although Medicaid expansion is one of the key ways that uninsured patients will gain health coverage through the ACA, not every state is participating. Currently, 28 states (including Washington, D.C.) are implementing Medicaid expansion, 2 states are in open debate, and 21 states are not expanding. As a result of the Medicaid expansion, approximately 10.5 million new patients will receive health insurance coverage. However, many of these patients will remain “functionally” uninsured because they will lack access to providers who are willing to accept new Medicaid patients. (Less than half of physicians are accepting new Medicaid patients.) Think Tank participants also emphasized the growing importance of care coordination in oncology since more patients are living longer with a cancer diagnosis and are requiring care by other specialists such as cardiologists or psychiatrists.
Value in Oncology
Think Tank participants agreed that the growing focus around the “value” of healthcare can be difficult to measure in the area of oncology. The measurement of subjective clinical endpoints can be challenging when cancer patients are dealing with severe nausea or vomiting, fatigue, rashes, or pain. Cancer programs and oncology clinicians are also noting the growing importance of focusing on patient satisfaction scores, since these metrics are directly impacting reimbursement.
Think Tank participants also acknowledged that other complex and intertwined issues related to healthcare reform are directly impacting cancer providers and patients. There are ongoing discussions about the 340B Drug Pricing Program, the consolidation and acquisition of oncology practices, and of creative ways for achieving patient-centered care in oncology.
Stay tuned for Think Tank #3 Discussing Personalized Medicine at #ACCC2014.