California Aims for Equity by Redefining Cancer Care

California's initiative to tackle disparities in cancer care has taken a decisive step forward with the implementation of the California Cancer Care Equity Act (CCCEA). Enacted on March 1, 2023, this legislation aims to provide 13.9 million Medi-Cal beneficiaries with enhanced access to optimal cancer care services.

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A Viewpoint article in JAMA Oncology highlighted key aspects of the CCCEA, such as its focus on Medi-Cal beneficiaries, the requirement for managed care plans to contract with specialized cancer centers, and the definition of complex cancers. The authors suggested potential improvements to the policy, including expanding the definition of complex cancers and addressing barriers beyond access to specialists.

The importance of ongoing monitoring and data collection to ensure the CCCEA's effectiveness in improving access to care and reducing disparities in cancer outcomes was also emphasized. Overall, the article positioned the CCCEA as a fundamental shift in cancer health policy and advocated for its safe and effective implementation to achieve cancer equity in California.

Addressing Disparities in Cancer Care

The CCCEA mandates that Medi-Cal–managed care plans (MCMCPs) make a good faith effort to contract with specialized cancer centers capable of treating complex cancer diagnoses. Complex cancers, as defined by the bill, encompass cases where there is no standard FDA-approved treatment or where known highly effective therapies have failed. According to the article, this legislative move is a crucial step toward recognizing and rectifying the disparities in access to high-quality comprehensive cancer care, particularly for Medicaid-insured patients who often experience suboptimal outcomes related to cancer diagnosis.

Expanding Access and Reducing Disparities

While the CCCEA expands the network of cancer centers within MCMCPs, the definition of complex cancers may be too narrow, the authors stated. The current criteria focus on advanced-stage cancers, potentially missing the opportunity for early intervention, which is critical for achieving better outcomes. The article suggested expanding the definition of complex cancer to include early-stage diagnoses, emphasizing the importance of multidisciplinary care for improved results.

Removing Barriers to Care

The CCCEA empowers patients by allowing them to request referrals to specialty cancer hospitals for complex cancer diagnoses. However, the authors addressed the need for clarity on how plans will facilitate these referrals. Beyond accessing specialists, the CCCEA must address other barriers such as out-of-pocket costs, transportation, health literacy, and cultural considerations. The importance of data collection to monitor the efficacy of the CCCEA, ensuring that it achieves its goal of increasing access to care and improving cancer outcomes, was stressed.

Community Partnerships for Success

While data are being collected by the California Department of Health Care Access and Information and the California Cancer Registry, the article addressed the role of community partnerships in leveraging this data. These partnerships can enhance accountability, identify patient-specific barriers, and help ensure that the CCCEA is achieving its intended effects.

The CCCEA represents a pivotal shift in cancer health policy, targeting structural and systemic drivers of disparities. The authors acknowledged the inherent trade-offs in implementing such a policy as well as the opportunities it presents to expand access to optimal cancer care services.

"Furthermore, a formal policy evaluation plan should be established to ensure that the plan is achieving cancer equity for California," they wrote. "Doing so would reaffirm California’s commitment to improving cancer care and demonstrate to the rest of the nation a model for addressing social determinants of health and inequities in cancer care."

Reference

Diaz A, Loehrer A, Pawlik TM. Expanding access to high-quality cancer care through policy—California Cancer Care Equity Act. JAMA Oncol. Published online November 22, 2023. doi:10.1001/jamaoncol.2023.5010