Cost of cancer drugs is top 2016 challenge cited by community cancer centers

The top challenge of 2016 was the cost of cancer drugs, according to results from the the seventh annual “Trends in Cancer Programs” survey from the Association of Community Cancer Centers (ACCC). Survey respondents also recognized that the escalating cost of care is driven only in part by drug costs.

This annual report from the ACCC provides insights in nationwide development in the business of cancer care.

To face the cost challenge, ACCC member programs reported that they have been proactive. According to one respondent, who is a medical director: “We stay on formulary as much as possible; keep less effective drugs off formulary; use our financial counselors and pharmacists to help reduce patient cost.”

Another trend, noted by 66% of respondents, was that the lack of reimbursement for supportive care services that are key elements of patient-centered care—including patient navigation, survivorship care planning, and financial counseling—are still a critical issue.

“While ACCC member cancer programs have made great strides in advancing patient-centered care, it’s clear that payer policies are lagging behind,” said ACCC President Jennie R. Crews, MD, MMM, FACP. “Reimbursement for these services is especially critical as we transition to new models of cancer care delivery such as the Oncology Care Model (OCM) and the Merit-Based Incentive Payment System (MIPS).”

Increased transparency in commercial insurance policies to help patients easily understand what these services plans cover or do not cover was also cited by 64% of respondents. In light of changes that will occur under the new Administration, ACCC member programs have successfully targeted transparency. One cancer program administrator shared: “[We] have put together a cost transparency group to determine how we can provide education and assistance to patients who have been prescribed high-cost chemotherapies or immunotherapies.”

A critical need for physicians and mid-level providers to focus on direct patient care instead of paperwork was cited by 55% of respondents. This arose from the increasing number of providers facing constant changes in health care and an increasing number of mandatory reporting programs.

Said one radiation oncologist: “Paperwork continues to increase and takes away from the doctor and patient interaction.” An oncology nurse shared a similar concern, “... Payers should work with those in the trenches [providers] to make pre-certifications easier ... Get non-clinical personnel off the phones and let providers speak with decision makers.”

Some of the innovative strategies employed by ACCC Member Cancer Programs aimed at reducing costs and ensuring quality care include the following:

• Lean initiatives focused on streamlining processes and improving quality of care (62%);
• Working with physicians to reduce unnecessary hospitalizations (60%); and
• Adding services, including oncology rehabilitation, nurse call centers for symptom management, and nurse practitioner-based survivorship care (57%).

One respondent, a cancer program administrator, shared: “[We] are adding a hospitalist to our inpatient services to allow for better coverage; planning a symptom management clinic to prevent unnecessary wait times in EDs and hospitalizations.”

Another respondent, a medical director, outlined some of the strategies they implemented to achieve these goals: “Nurse navigators who coordinate care. Extended hours—we now provide urgent care throughout the day. Our financial counselors meet with almost every patient.”