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.
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.
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.
A new article looks at how evidence-based medicine can help reduce the cost of cancer treatment. Here’s the situation:
The high cost of oncology is gaining a lot of attention these days. With cancer care accounting for ten percent of healthcare costs, payers are hungry to find ways to be more frugal. As oncologists, it is in our best interest, as well as the best interest of our patients, to take a proactive, leadership role in finding solutions that sustain our ability to deliver high-quality care.
OK, sounds good. How do we accomplish this? One idea:
A study by Milliman analyzing Medstat 2007 data revealed that out of those chemotherapy patients with 10 major cancer diagnoses who were identified as dying in an inpatient setting, 24% received chemotherapy within 14 days of death and 51% received chemotherapy within 30 days of death. While we cannot always predict when death will occur, pathways can help guide physicians in making decisions and treatment recommendations pertaining to whether to offer additional cycles of a treatment or move to second, third, and further lines of treatment. They can also provide practical guidance that can be helpful in end-of-life care discussions. This includes demonstrating that transitioning to hospice care can improve the patient’s and the family’s quality of life and can reduce the costs borne by the family and payers by avoiding unnecessary and ineffective chemotherapy administered within a few weeks of death.
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.
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.