Hot topics in cancer care delivery and payment innovation — 5 takeaways

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As health systems work to reduce costs and embrace medical advancements, cancer centers must find ways to align the care they deliver with reimbursement that will keep them financially viable.

In addition, patient expectations for better access are rising, forcing cancer centers to improve operations.

During a virtual session sponsored by ECG Management Consultants as part of the Becker's Oncology Virtual Forum in July, five oncology experts discussed payer policy trends, pressures from changing reimbursement and patient access issues:

  • Jessica Turgon, Principal, ECG
  • Jim Donohue, Associate Principal, ECG
  • Stephanie Hobbs, Associate Principal, ECG
  • Robin Settle, Principal, ECG
  • Linsey Gregory, Director of Managed Care, The University of Kansas Health System in Kansas City

Five key takeaways:

1. Recent payer initiatives are focused on cost containment and may negatively impact oncology services and financial viability. Payers want to commoditize and reduce cost in targeted areas such as drugs/pharmacy, labs and diagnostic imaging. Requirements to outsource pharmacy and lab services are growing in popularity among payers to reduce costs. According to Mr. Donohue, when plans require that "the fulfillment of drugs are provided by outside pharmacies," this can negatively affect cancer centers that are reliant on those reimbursements. In addition, the outsourcing of labs and imaging are particularly concerning. "These help accurately and quickly diagnose patients so they can begin the most effective treatment plan," he said. "And the timing of that is critically important, and cannot always be outsourced."

2. Payers are pushing care to lower-cost sites of care. "Years ago, cancer was treated in an inpatient setting," Ms. Gregory said. "Now, payers and patients are demanding lower-cost settings like free standing ambulatory clinics or even home infusion." Other clinical and technological advancements in oncology include shorter courses of treatment and personalized medicine. As these changes occur, provider organizations need to evaluate and revisit their payer contracts to ensure they are aligned with payment models.

3. Being proactive during open contract negotiations as well as aware of contract language provides reimbursement flexibility and protection. Ms. Gregory recommended knowing "the trends and market, to be proactive during open contract negotiations." Incorporate language that prevents payers from unilaterally making changes to reimbursement structures. "It's important to clarify that the treatment course still resides with clinicians, yet be open to jointly working to address costs," she added. Mr. Donohue pointed out that some state laws may provide an option for remedy as well, even if reimbursement changes or policy revisions are not outlined within the contract.

4. Bolstered by changes in care during the pandemic, patients are expecting greater quality, convenience, availability and affordability. "With the [increase] of telehealth during COVID, patients are expecting they will be able to access providers in a virtual, frictionless way moving forward," Ms. Turgon said. According to Ms. Hobbs, some well-known hospitals have responded by focusing on what the patient wanted in terms of access. This has led to providing efficient new appointment access and extended hours for weekend virtual visits. "When it came to new patient access, we created a dedicated access center with a single point of contact and standardized all processes and guidelines," she said.

5. Cancer centers must streamline internal operations to improve access. According to Ms. Settle, to operate more efficiently and lower costs, health systems with cancer centers must make operational changes such as simplifying appointment templates, providing more sessions, better managing bump rates, minimizing private slot times and creating provider incentives to increase patient access.

To learn more about the event, click here.

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