Healthcare Town Hall

Nebraska recently enacted a chemotherapy parity law requiring insurance companies to insure oral chemotherapy the same as intravenous cancer treatments. This article in the Lincoln Journal Star cites a 2010 study conducted by Kate Fitch, Kosuke Iwasaki, and Bruce Pyenson on the cost-sharing of oral and intravenous cancer drugs.

Here is an excerpt from the article:

Sen. Jeremy Nordquist of Omaha, who spearheaded the legislation in Nebraska, said the lack of parity in coverage between intravenous and oral chemotherapy medications is a growing problem. Some cancer treatments cost $5,000 to $10,000 a month, and some patients are being forced to pay high out-of-pocket costs for chemotherapy taken orally.

“This … will make life-saving cancer treatments more accessible and affordable for cancer patients,” he said. “The decision about the best course of treatment, whether it be IV chemo or chemo in a pill form, will be made between patients and their doctor, not dictated by their insurance company.”

Nordquist said research shows that when confronted with the reality of high out-of-pocket expenses, many cancer patients forgo expensive therapy and discontinue treatment, in part because they do not want to saddle their families with unmanageable debt.

And because oncologists know how expensive oral medications can be, he said, they often do not prescribe them — even when they think that would be the best option.

The actuarial and benefits consulting firm Milliman Inc. did a study in 2010 that estimated that requiring similar coverage for oral chemotherapy would cost less than $6 a year per person in most insurance plans.

To read the entire Milliman study, click here.

Cancer Bruce Pyenson, Cancer, chemotherapy, Kate Fitch, Kosuke Iwasaki

The Washington Post looks at oral oncology and the way insurers pay for such drugs. Here is an excerpt:

People who get traditional IV chemotherapy on an outpatient basis often pay a flat co-payment that covers the drug as well as the cost of administering it. Annual out-of-pocket costs are also typically capped.

Oral anti-cancer medications, on the other hand, are generally considered a pharmacy benefit. Instead of a co-payment, plan members often pay a percentage of the drugs’ cost — up to 50 percent, in some cases — with no annual out-of-pocket limit. And these drugs are expensive, often costing tens of thousands of dollars a year.

In recent years, states have stepped in to address the problem. Since 2007,
19 states and the District have passed laws requiring insurers to provide coverage for oral cancer drugs that is equivalent to infusion drugs, according to the National Patient Advocate Foundation. Five states, including Virginia and Maryland, have passed laws in 2012 alone, and others are considering proposals, according to advocacy groups.

Is oral chemotherapy a cost-effective way to treat cancer? The article addresses this question:

But oral oncology parity laws don’t necessarily drive up costs. According to a 2010 study by benefits consultants Milliman, the estimated cost to most health plans for complying with oral oncology parity laws would be less than 50 cents per member per month.

Cancer Cancer, chemotherapy, Kate Fitch

A new bill before the Nebraska legislature seeks to achieve parity between how insurance policies handle chemotherapy administered by IV versus chemotherapy administered via oral medications. Here are some details from an Association Press article:

The measure by Omaha Sen. Jeremy Nordquist seeks to address what supporters see as a disparity between how the two cancer treatments are classified: Insurance policies usually cover the cost of IV chemotherapy as a medical benefit, while oral medications are viewed as prescription drug benefits with much larger copayments.

Nordquist said the idea for the bill came from his brother, an Omaha oncologist, who reported encounters with roughly half a dozen patients who could not afford the preferred cancer treatment in pill form. He pointed to a study by Milliman Inc., a national health care consulting firm, which found that the per-payer increase ranged from 5 cents to $1.50.

To see the full Milliman report on oral chemotherapy, go here.

Cancer Bruce Pyenson, Cancer, chemotherapy, Kate Fitch

US Oncology today announced the publication of a study that highlights the savings potential for cancer patients when their treatment is consistent with evidence-based guidelines. Here is an excerpt:

 A study conducted by The US Oncology Network and Milliman finds that colon cancer treatment that is consistent with evidence-based guidelines (specifically Level I Pathways) has significantly lower cost while demonstrating outcomes similar to those in published literature. The study shows mean per patient cost differences of more than 30 percent, $53,000 for the treatment of adjuvant colon cancer and $60,000 for the treatment of metastatic colon cancer. The study, which compared patients whose care followed physician-developed Level I Pathways evidence-based guidelines (also known as ‘on pathway’) to other patients (‘off pathway’), was published in a special joint peer-reviewed issue of the Journal of Oncology Practice (JOP) and the American Journal of Managed Care (AJMC).

The full announcement is available here.

Cancer Bruce Pyenson, Cancer, evidence-based medicine

An announcement by US Oncology points to a new study that explores a road map toward improved efficiency in cancer care. Healthcare IT News has the story; here’s an excerpt:

The study suggests that leveraging healthcare IT, shared best practices, refined evidence-based medicine guidelines and quality measurements, contribute to the quality, safety and science of cancer care to improve patient outcomes.

Titled “Benchmarks for value in cancer care: an analysis of a large commercial population,” the report found that the key areas driving the spike in costs are chemotherapy, hospital admissions, emergency room visits and aggressive end-of-life care.
 
Cancer patients in a commercially insured population receiving chemotherapy averaged $111,000 per year in total medical and pharmacy costs – about four times the cost of cancer patients not receiving chemotherapy and nearly 26 times the cost of non-oncology patients. More than half of the cancer patients in the study received chemotherapy within the last 30 days of life.

The study was published in the “State of Oncology” supplement of the peer-reviewed Journal of Oncology Practice…The US Oncology Network partnered with Milliman, Inc. to evaluate the prevalence and costs associated with cancer treatment in a commercially insured population. They used Medstat 2007, a large commercial insurance database that contains private sector health data and claims information for about 14 million insured lives from approximately 100 payers.

Fourteen cancer diagnoses were included and evaluated in ten cancer groups including lung, breast, colon, rectal, pancreatic, ovarian, multiple myeloma, lymphoma, chronic lymphocytic leukemia and prostate. Study endpoints included analyzing the cost of treatment over one year and costs incurred at the end of life.

Cancer Bruce Pyenson, Cancer, EHR

Some of you may remember this interview from last May, which explained the results of a 2009 study for the Lung Cancer Alliance that used actuarial methods to clarify the opportunity posed by lung cancer screening.

The case for increased lung cancer screening gained more momentum last week when the Los Angeles Times reported on the results of an analysis by the National Cancer Institute. Here is an excerpt from the Times article:

Advanced CT imaging can reduce deaths from lung cancer by 20% among heavy smokers by detecting tumors at an earlier stage when they are more treatable, according to results released Thursday from the first study to compare the value of CT scans and regular chest X-rays for lung cancer screening.

The long-awaited results of the trial involving more than 53,000 former and current heavy smokers were so conclusive that the study was terminated ahead of schedule last week and letters were sent to all the participants advising them of the results.

The findings are considered a major step forward in fighting the most deadly form of cancer — which is expected to kill an estimated 157,000 Americans this year — because chest X-rays have never been proven to be an effective tool for identifying tumors. CT scans are more powerful and provide a much clearer picture of the lungs.

Cancer, Prevention Bruce Pyenson, Cancer, Sara Goldberg

We’ve been tracking the emergence of a cancer-focused accountable care organization (ACO). In a new interview, US Oncology executive vice president Grant Bogle discusses this concept with the Bureau of National Affairs. See the full interview here.

Accountablity, Cancer ACOs, Bruce Pyenson, Cancer

We have blogged before about cancer-focused accountable care organizations (ACOs). Recent developments in California continue that trend. Healthcare IT has the story:

The Association of Northern California Oncologists (ANCO) recently selected Via Oncology Pathways as a preferred pathways option for its nearly 400 members. Via Oncology Pathways will provide ANCO’s hematologist and oncology community with clinical algorithms that will help them standardize best practices for cancer treatment while optimizing patient outcomes and promoting the efficient use of treatment resources…

The announcement of the deal comes as payers and providers alike seek to find ways to control the cost of cancer therapies while also providing treatment regimens that are known to improve outcomes. In a similar deal last month, Innovent Oncology, a division of US Oncology, announced a continuing relationship with accounting powerhouse Milliman, to help provide outcomes data US Oncology can then use to negotiate oncology treatment contracts with payers.

See the full article here.

Cancer ACOs, Bruce Pyenson, Cancer

A new study commissioned by Innovent Oncology looks at cancer-related utilization. The study, which was announced today, identifies both regional variation as well as ways to improve quality and efficiency in cancer treatment. Here is an excerpt from the press release:

Innovent Oncology commissioned Milliman’s [Kate] Fitch and co-authors in New York to evaluate 10 of the most common cancer types where chemotherapy is a key treatment modality. The utilization and cost metrics examined include: chemotherapy-related hospitalizations; chemotherapy-related emergency room visits; chemotherapy costs; and end-of-life care including hospice enrollment, death in a hospital and chemotherapy administration within 2 to 4 weeks of dying.

The study used a nationally representative claims database of 14 million commercially insured lives. The 10 cancers identified in the study account for 65% of cancer patients in a commercial population and approximately 25% of these cancer patients received chemotherapy treatment during the observation year. The members receiving chemotherapy and having one of the 10 cancers make up about 0.11% of commercial members, but account for about 4% of overall healthcare costs.

Regional variation is identified with respect to the first three metrics listed above. Chemotherapy-related inpatient admissions and emergency room visits show a two-to-three fold regional difference in rates and chemotherapy drug costs range from $17,000 to $27,000. These regional differences suggest opportunities for health plans and plan sponsors to improve quality, thereby reducing cost and utilization.

Proactive end-of-life care provides patients with higher quality care and both patients and payers with additional quality and cost savings opportunities. For chemotherapy patients with the 10 cancers that were identified as dying in an inpatient setting, 24% received chemotherapy within 14 days of dying and 51% received chemotherapy within 30 days of dying.

“This is a comprehensive commercial payer view of cancer patients receiving chemotherapy and various cost drivers,” says Kate Fitch, RN, MEd, Principal and Healthcare Management Consultant with Milliman. “We are very pleased that Innovent Oncology is publishing this report, especially because there is a growing concern over variation and waste in cancer care.”

Read more…

Cancer, Quality of Care Cancer, Kate Fitch, Utilization

The Lung Cancer Alliance issued a press release today announcing results of a study on early-stage screening for lung cancer. Here is an excerpt:

The first ever actuarial analysis of lung cancer mortality, published today in Population Health Management Journal,  provides strong evidence that earlier detection could reduce the number of late stage lung cancer deaths by over 70,000 people each year in the US. Calling the number “profound,” Lung Cancer Alliance (LCA) President Laurie Fenton-Ambrose said, “This would be the equivalent of eliminating all deaths from breast and prostate cancer each year.  It clearly demonstrates why we must make research and development of earlier detection tools for lung cancer a public health priority.”  

The study was carried out by Milliman Inc., an internationally renowned actuarial firm, and commissioned by Lung Cancer Alliance, the American Legacy Foundation, the Bonnie J. Addario Lung Cancer Foundation, Joan’s Legacy Foundation, Lungevity Foundation, the Prevent Cancer Foundation and the Thomas G. LaBrecque Foundation.

Bruce S. Pyenson, FSA, one of the co-authors of the study said, “We found that higher stage at diagnosis was profoundly associated with higher all-cause mortality and lower stage at diagnosis had profoundly lower all-cause mortality.”

“Our reporting all-cause mortality is perhaps more relevant to patients than the more common disease-specific survival or 5-year survival, as patients probably are more concerned about overall survival, not whether they face death from cancer, treatment side-effects, or something else,”  he noted.

The study analyzed detailed records of over 241,000 lung cancer patients diagnosed and treated between 1988 and 2003 from the Surveillance, Epidemiology and End Results (SEER) database of the National Cancer Institute.

Mortality rates from those records were compared to demographically- and year-adjusted standard national mortality rates to develop “load” mortality ratios. These show the added mortality burden that treated lung cancer brings to patients, and how that burden dramatically increases by stage.

Read the full press release here.

Cancer Bruce Pyenson, Cancer