Welcome!

News Feed Item

NCCN Roundtable Considers the Effect of Health Care Reform on Oncology Practice: Confronting Risk

The Second Roundtable of the NCCN 19th Annual Conference Explored the Affordable Care Act (ACA) and the New-Found Risk That Providers, Payers, and Patients Are Learning to Navigate

FORT WASHINGTON, PA--(Marketwired - March 19, 2014) - On Friday, March 14, 2014, the National Comprehensive Cancer Network® (NCCN®) hosted its second roundtable of the NCCN 19th Annual Conference: Advancing the Standard of Cancer Care™, titled, The Affordable Care Act: Where are We Now? Clifford Goodman, PhD, The Lewin Group, moderated the discussion, which explored the Affordable Care Act (ACA) and health care reform in the United States, its effect on the oncology landscape, and assessment of risk for providers, payers, and patients.

Dr. Goodman was joined by Christian G. Downs, JD, MHA, Association of Community Cancer Centers; Liz Fowler, PhD, JD, Johnson & Johnson; Michael Kolodziej, MD, Aetna; Lee H. Newcomer, MD, MHA, UnitedHealthcare; John C. Winkelmann, MD, Oncology Hematology Care, Inc., and Councillor, American Society of Hematology; Mohammed S. Ogaily, MD, Henry Ford Health System; and W. Thomas Purcell, MD, MBA, University of Colorado Cancer Center.

Dr. Goodman opened Friday's roundtable discussion by asking Dr. Purcell how, since the implementation of the ACA, patients have been presenting differently than in previous years.

Dr. Purcell described how, at University of Colorado Cancer Center, two distinct groups have presented since the ACA: medically indigent adults and newly underinsured patients who, for the first time, are within a narrow network and do not have the same access to comprehensive care that was previously available through employer-sponsored programs. These groups, he said, now qualify for Medicaid or have purchased Bronze Packages; however, both are accompanied by large co-pays.

Due to the well-run state exchange and Medicaid expansion in Kentucky, said Dr. Winkelmann, adult patients are, for the first time in years, seeing their primary care physicians. In turn, he said, oncologists are experiencing an influx of newly insured patients because they have undergone overdue routine cancer screening.

Patients who recently acquired health care and who have been putting off treatment are now presenting with complex cases that require an immediate need, added Dr. Ogaily.

Dr. Fowler and Mr. Downs explained that this poses risk in oncology because, when the ACA was first implemented, young, healthy patients (less than 35 years old) were expected to sign up in multitudes. To the contrary, Mr. Downs added, a risk pool has emerged as the majority of new enrollees are around the age of 55, and this demographic is more likely to have cancer, require expensive treatment, and carry other comorbidities.

Dr. Goodman asked Dr. Kolodziej and Dr. Newcomer how, as payers, they are assessing their risk with more patients requiring more expensive care.

Drs. Kolodziej and Newcomer agreed that, given the fact that the market has been open for less than 90 days, the necessary claims data is not available to adjust premiums.

"We are trying to understand how the process works," said Dr. Newcomer. "And, then we are ready to get fully committed and expand as soon as we understand how it's going to work."

"Given the uncertainty, you manage what you can manage," said Dr. Kolodziej. "Many of the strategies to manage the risk of this unknown pool are the same strategies we use to manage the risk in the pool that we do know about."

"If the risk pool stays risky, does it all fall apart?" Dr. Goodman asked Dr. Fowler.

"Congress and the public need to think about what adjustments they need to make," said Dr. Fowler, who, prior to her employment at Johnson & Johnson, worked with the U.S. Senate and at the White House on the authoring and implementation of the legislature. Dr. Fowler explained that there are three mechanisms for self-correction -- referred to as the premium stabilization programs -- built into the law to make amends for enrolling sick people up front: the temporary reinsurance program, the temporary risk corridor program, and permanent risk adjustment.

According to the panel, risk is not only eminent for payers and providers, but also for patients. Quality of care is a major concern for patients with rare diseases, explained Dr. Purcell. Because patients with rare cancers require state-of-the-art treatment that is not always available in the community setting, they seek care at larger, academic centers that are not covered within their narrow markets, and these patients are forced to pay for their care out of pocket. 

And, with more and more community oncology practices being purchased by larger hospitals, financial risk is eminent for patients, said Dr. Ogaily. Trying to work through a hospital is more difficult and more time consuming, therefore, raising administrative costs, he said, adding that those costs are transitioned to the patients.

Further, if a community practice is purchased by a hospital, said Dr. Newcomer, payers are seeing as much as a 10-fold rise in drug costs. Patients, then, make up for the rise in cost through co-pays and deductibles, and the provider pays the difference, he explained.

"We can all agree that there is a lack of transparency and this discussion degenerates into a qualitative versus a quantitative argument," said Dr. Kolodziej. "The solution is shifting risk."

"What we need to do, collaboratively, is work on reducing administrative expenses," said Dr. Newcomer. "It's going to take discussions, it's going to take experiments, and it's going to take a blank piece of paper."

In closing, Dr. Goodman asked the panel to discuss what they believe the keys for successful implementation of the law will be. The answers: integrated care, payment reform, and an increased focus on value and quality.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred and Pamela Buffett Cancer Center at The Nebraska Medical Center, Omaha, NE; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan-Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients.

The following files are available for download:

More Stories By Marketwired .

Copyright © 2009 Marketwired. All rights reserved. All the news releases provided by Marketwired are copyrighted. Any forms of copying other than an individual user's personal reference without express written permission is prohibited. Further distribution of these materials is strictly forbidden, including but not limited to, posting, emailing, faxing, archiving in a public database, redistributing via a computer network or in a printed form.

Latest Stories
SYS-CON Events announced today that IBM has been named “Diamond Sponsor” of SYS-CON's 21st Cloud Expo, which will take place on October 31 through November 2nd 2017 at the Santa Clara Convention Center in Santa Clara, California.
A look across the tech landscape at the disruptive technologies that are increasing in prominence and speculate as to which will be most impactful for communications – namely, AI and Cloud Computing. In his session at 20th Cloud Expo, Curtis Peterson, VP of Operations at RingCentral, highlighted the current challenges of these transformative technologies and shared strategies for preparing your organization for these changes. This “view from the top” outlined the latest trends and developments i...
When growing capacity and power in the data center, the architectural trade-offs between server scale-up vs. scale-out continue to be debated. Both approaches are valid: scale-out adds multiple, smaller servers running in a distributed computing model, while scale-up adds fewer, more powerful servers that are capable of running larger workloads. It’s worth noting that there are additional, unique advantages that scale-up architectures offer. One big advantage is large memory and compute capacity...
In 2014, Amazon announced a new form of compute called Lambda. We didn't know it at the time, but this represented a fundamental shift in what we expect from cloud computing. Now, all of the major cloud computing vendors want to take part in this disruptive technology. In his session at 20th Cloud Expo, Doug Vanderweide, an instructor at Linux Academy, discussed why major players like AWS, Microsoft Azure, IBM Bluemix, and Google Cloud Platform are all trying to sidestep VMs and containers wit...
"Loom is applying artificial intelligence and machine learning into the entire log analysis process, from start to finish and at the end you will get a human touch,” explained Sabo Taylor Diab, Vice President, Marketing at Loom Systems, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
"We are a monitoring company. We work with Salesforce, BBC, and quite a few other big logos. We basically provide monitoring for them, structure for their cloud services and we fit into the DevOps world" explained David Gildeh, Co-founder and CEO of Outlyer, in this SYS-CON.tv interview at DevOps Summit at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
In his session at @ThingsExpo, Eric Lachapelle, CEO of the Professional Evaluation and Certification Board (PECB), provided an overview of various initiatives to certify the security of connected devices and future trends in ensuring public trust of IoT. Eric Lachapelle is the Chief Executive Officer of the Professional Evaluation and Certification Board (PECB), an international certification body. His role is to help companies and individuals to achieve professional, accredited and worldwide re...
With major technology companies and startups seriously embracing Cloud strategies, now is the perfect time to attend 21st Cloud Expo October 31 - November 2, 2017, at the Santa Clara Convention Center, CA, and June 12-14, 2018, at the Javits Center in New York City, NY, and learn what is going on, contribute to the discussions, and ensure that your enterprise is on the right path to Digital Transformation.
New competitors, disruptive technologies, and growing expectations are pushing every business to both adopt and deliver new digital services. This ‘Digital Transformation’ demands rapid delivery and continuous iteration of new competitive services via multiple channels, which in turn demands new service delivery techniques – including DevOps. In this power panel at @DevOpsSummit 20th Cloud Expo, moderated by DevOps Conference Co-Chair Andi Mann, panelists examined how DevOps helps to meet the de...
Automation is enabling enterprises to design, deploy, and manage more complex, hybrid cloud environments. Yet the people who manage these environments must be trained in and understanding these environments better than ever before. A new era of analytics and cognitive computing is adding intelligence, but also more complexity, to these cloud environments. How smart is your cloud? How smart should it be? In this power panel at 20th Cloud Expo, moderated by Conference Chair Roger Strukhoff, pane...
@DevOpsSummit at Cloud Expo taking place Oct 31 - Nov 2, 2017, at the Santa Clara Convention Center, Santa Clara, CA, is co-located with the 21st International Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The widespread success of cloud computing is driving the DevOps revolution in enterprise IT. Now as never before, development teams must communicate and collaborate in a dynamic, 24/7/365 environment. There is ...
No hype cycles or predictions of zillions of things here. IoT is big. You get it. You know your business and have great ideas for a business transformation strategy. What comes next? Time to make it happen. In his session at @ThingsExpo, Jay Mason, Associate Partner at M&S Consulting, presented a step-by-step plan to develop your technology implementation strategy. He discussed the evaluation of communication standards and IoT messaging protocols, data analytics considerations, edge-to-cloud tec...
What's the role of an IT self-service portal when you get to continuous delivery and Infrastructure as Code? This general session showed how to create the continuous delivery culture and eight accelerators for leading the change. Don Demcsak is a DevOps and Cloud Native Modernization Principal for Dell EMC based out of New Jersey. He is a former, long time, Microsoft Most Valuable Professional, specializing in building and architecting Application Delivery Pipelines for hybrid legacy, and cloud ...
Amazon started as an online bookseller 20 years ago. Since then, it has evolved into a technology juggernaut that has disrupted multiple markets and industries and touches many aspects of our lives. It is a relentless technology and business model innovator driving disruption throughout numerous ecosystems. Amazon’s AWS revenues alone are approaching $16B a year making it one of the largest IT companies in the world. With dominant offerings in Cloud, IoT, eCommerce, Big Data, AI, Digital Assista...
SYS-CON Events announced today that CA Technologies has been named "Platinum Sponsor" of SYS-CON's 21st International Cloud Expo®, which will take place October 31-November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. CA Technologies helps customers succeed in a future where every business - from apparel to energy - is being rewritten by software. From planning to development to management to security, CA creates software that fuels transformation for companies in the applic...