NCCN Working Group Policy Recommendations Address Changing Paradigms in Cancer Care

With new, innovative therapies hitting the marketplace at a rapid pace, policies often lag behind the medical innovation. A National Comprehensive Cancer Network (NCCN) working group dedicated to analyzing current challenges under existing policy and treatment paradigms presented their findings and recommendations at an NCCN Policy Summit in Washington, DC.

Delivering innovative treatment

Leonidis C. Platanias, MD, PhD, director, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, outlined several policies needed for protecting patient access to high-cost, high-impact therapies, including value-based mechanisms to reimburse costs outside of bundled payments and modernizing reimbursement systems, particularly in CMS, to accommodate novel therapies and advanced diagnostic tools.

Once innovative therapies hit the market, there is a need for professional organizations, such as NCCN, tasked with developing tools, standards, and evidence-based guidance, for the implementation of the therapies, Platanias said. Dissemination mechanisms, such as education and peer-to-peer networks, also need to be developed for delivering these therapies, as well as strategies to measure their quality , he added. With the growing emergence of precision medicine biomarkers and clinical indications for therapies, there needs to be a framework or guidance document for evaluating each clinical utility.

Team-based care coordination

Recognizing the importance of supporting team-based care, Platanias put an emphasis on policies that promote and reward such coordination. Policies need to expand beyond the Oncology Care Model (OCM) to new, team-based payment models that identify best practices for promoting high-value cancer care, he explained.

Achieving this, in part, can be done through more collaboration between the Physician-Focused Payment Model Technical Advisory Committee (PTAC) and HHS, as well as through more technical assistance from PTAC before and after proposal submissions.

Policies should establish reimbursement and coding mechanisms to support team-based models of care, he added.

Value-based payment models

Warren Smedley, MSHA, MSHQS, service line director, cancer, University of Alabama at Birmingham Health System, put a large focus on the need for greater electronic health record interoperability through policy. While he noted promise with CMS’ shift from meaningful use to interoperability, he cautioned that there are still unmet needs. The majority of patients access at least 2 health systems for their care, and nearly half access 3 health systems, highlighting a need for sharing data between health systems.

“Without interoperability, it will be very difficult for us,” Smedley explained. “How can we jump into a value-based model if we can’t see what’s going on and we can’t manage across different health systems?”

He underscored the need for greater transparency through the availability and exchange of claims data from CMS and private payers to providers, while also focusing on greater clarity through guidance documents that address regulatory hurdles, such as HIPAA, that might prevent data sharing.

With different stakeholders holding different definitions of value, there is a need for developing standardized metrics and a shared definition of value in collaboration with both providers and patients, he added.

Shortages and diversity in the cancer care workforce

We are currently at a time when patients are living longer, translating to bigger cancer populations, while simultaneously struggling with physician shortages, explained Smedley. A large part of this can be addressed through inter-state partnerships for practicing across state lines, either by traveling across state lines or by practicing telemedicine. This is particularly important in underserved areas, largely rural areas, that struggle with access to care.

“The technology is finally here to make it work, but state regulations make it hard to roll it out,” said Smedley. “We need to focus on reimbursement for telemedicine.”

As providers care for larger populations of cancer patients, Smedley echoed the call for payment models to support care team providers, such as community health workers, patient navigators, genetic counselors, dieticians, and pharmacists.