Managed Care Strategies in Multiple Myeloma

Steven Peskin, MD, MBA, FACP: How do we approach multiple myeloma, as it is neither very common nor extremely rare? We have some programs that [concentrate] around what we call episodes of care and bundled payment. And right now, those are focused in the more prevalent cancer types. We’re talking about non—small cell lung cancer, colorectal cancer, breast cancer, and non-Hodgkin’s lymphoma. There’s not an episode of care that we’ve developed or modeled, yet, in multiple myeloma. We certainly recognize some of the important advances that have happened over the last decade in the treatment and management of multiple myeloma, which have been very positive for those individuals who have that diagnosis. But, we haven’t done anything in particular as it relates to multiple myeloma, beyond the work that we do in all cancer diagnoses when working with our clinical partners to ensure the best care, the right care, the right treatment, the right place and right time, and the right setting—[there’s] nothing specific as it relates to multiple myeloma.

How large of a concern is monoclonal gammopathy of uncertain significance in multiple myeloma? Again, we don’t have any particular programs, or protocols, or clinical care management pathways in this regard. We certainly would expect our clinical partners to be appropriately monitoring and making considerations about when is the best time, or right time to initiate certain treatment. But that’s not an area where we’ve developed any particular guidelines or care management pathways.