Articles

Applying the right solutions and tactics is no easy fiduciary task for Payers when they attempt to balancing costs with value Beyond OCM the Managed Care Payer market makers have increasingly stepped up in their intentions to innovate, apply more oversight, management, and new benefit design in response to the escalating cost of cancer care in the past year.

NCI, NIH and NCCN Cancer Centers of Excellence have played an important role in the delivery of cancer research and innovation cancer care today and for the foreseeable future. While these organizations have driven Integrated care a model concept for bringing together input, delivery, management, and organization of services related to diagnosis, treatment, care, rehabilitation, and health promotion managing the costs of cancer remain a challenge.

The American Cancer Society’s Cost-of-Cancer-2020 report projects oncology healthcare expenditures, currently over $200 Billion, will increase by 34% by 2030. This report also indicates private insurance purchases 49% of this total, with patient out-of-pocket costs representing another 5% of the total oncology healthcare expenditures.

The 340B program is always subject to scrutiny, criticism, and controversy. Although some believe the 340B program is not operating as envisioned, there are still several benefits derived under the program. The panel will have a lively discussion on what currently is the good and not-so-good impact of the 340B program on the cancer care ecosystem.

Recent developments in the production and assembly of Real-World Evidence in healthcare have greatly accelerated interest in its applications for a broad array of valuable uses, including clinical trials, post-approval pathways, and especially the design and operationalization of value based relationships.

On average 60-70% of the total cost of cancer care being derived by the cost of innovative pharmaceuticals today. Industry experts, payers, and providers have all expressed the belief that pharma should have an active role in participating in the cost and risk of cancer outcomes.

The discussion will be on alternatives in contracting precision medicine to align incentives for mutual gain of all stakeholders and improvement in clinical outcomes with reduction in resource use and waste. As the science conformations indicates in cancer care we find there is an obligatorily need to add a precision medicine component, so how do we truly incorporate this into Value Based Agreements.

There are a lot of calls in the industry for the overhaul of the 340B program as it exists today. Many believe the program is not achieving the program’s intended purpose and mission. 340B entities have been caught between the crosshairs of reimbursement and network access agreements. This panel will discuss mission critical fixes to the 340B programs to bring them back in line with their intended objectives.

Many complexities exist in the oncology patient journey. Among these are obtaining product access for the patient and maintaining meaningful connection during treatment. A number of advances have occurred in the creation of digital support tools that are designed to improve provider benefit verifications, identify pre-certification and prior authorization requirements, find alternative sources of funding and enroll patients in manufacturer sponsored assistance programs.

Panel discussion on the future and shape of precision medicine. What will CAP/CLIA look like in relation to additional standards that allow for "certification". Will there be more regulatory oversight that both incents innovation but prevents poor quality testing from becoming widespread in availability.