Directors from Aetna, Inc, gathered recently with a panel of thought leaders to explore the evolution of the oncology medical home (OMH) against the backdrop of the company’s experiences in this area. The discussion, held in November at the Cancer Center Business Summit, highlighted initiatives Aetna has undertaken and options the company has explored in recent years.
The announcement in February of a new Oncology Care Model has brought a lukewarm response by the American Society of Clinical Oncology (ASCO). Developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and announced through the US Department of Health & Human Services, the new care delivery model encompasses a multipayer structure as well as incentivized and monthly per beneficiary payments to participating practices (see article on this page).
There has been renewed focus in recent years on moving healthcare reimbursement from a system that incentivizes volume to one that incentivizes value. Largely an effort to rein in costs, particularly those related to Medicare, this trend has cropped up in every major healthcare law in the past decade, from the Medicare Modernization Act in 2003 to the Patient Protection and Affordable Care Act (ACA) in 2010. In fact, the ACA allocated $10 billion to the new Center for Medicare & Medicaid Innovation, whose purpose is to develop and test innovative ways to pay providers. Even last year’s bipartisan, bicameral sustainable growth rate legislation ultimately tied payment updates to participation in some form of alternative payment arrangement.
Cyramza (Ramucirumab) Approved for the Treatment of Advanced Gastric Cancer and Metastatic Non–Small-Cell Lung Cancer
Gastric cancer and lung cancer impose a substantial burden on patients. In light of the high mortality rate and quality-of-life issues associated with these 2 types of cancer, there is a marked need for additional therapeutic options to improve outcomes for patients with gastric or lung cancer.
The following clinical trials are currently recruiting patients with brain cancer for inclusion in several investigations. Each trial description includes the NLM Identifier to use as a reference with ClinicalTrials.gov.
- Perifosine and Temsirolimus for Recurrent/Progressive Malignant Gliomas
- Valproic Acid, Radiation, and Bevacizumab in Children
- Palbociclib Isethionate for Treatment of Younger Patients
- Postapproval Study of NovoTTF-100A
- Photodynamic Therapy for Brain Tumors
- Genetically Modified Neural Stem Cells, Flucytosine, and Leucovorin
- Veliparib, Radiation Therapy, and Temozolomide for Younger Patients
- Selumetinib in Young Patients with Recurrent or Refractory Low-Grade Glioma
- Phase 1 Study of a Dendritic Cell Vaccine
- Carboplatin and Bevacizumab
If you are unable to work due to a sickness or injury, disability insurance can help you meet your expenses and maintain your standard of living. One of the options available when purchasing an individual disability insurance policy is the cost of living adjustment (COLA) rider.
Despite substantially higher costs, specialty drugs can offer value comparable with that of traditional medications under certain circumstances, according to a recent cost-effectiveness analysis covering 12 years of FDA drug approvals.
A panel of experts gathered recently to explore changes that are expected for oncology in the field of personalized medicine as well as their impact on future delivery systems. The panel discussion, held in November at the Cancer Center Business Summit, highlighted what appears to be a gap between the medical community and companies that provide testing for personalized medicine. At the same time, the panelists agreed that available data and information relating personalized medicine to cancer treatment choices is not yet being used to full efficacy, which presents an untapped opportunity for cancer patients.
Our inboxes are overflowing with news of the Oncology Care Model (OCM) that was announced by the US Department of Health & Human Services on February 12. Full details are being unveiled regarding this bundled payment model, which was developed by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, and practices are starting to assess the expectations of the program versus the risks and rewards of participation or a decision not to participate.
Cancer care expenditures in the United States are staggering, and are only expected to climb. In 2010, the total cost of cancer care was $125 billion. By 2020, with more individuals living with cancer as a chronic disease, costs are expected to grow by 39% and exceed $170 billion. Faced with this dramatic escalation of costs, providers, commercial payers, and the government are testing different methodologies for reimbursing cancer care. The aim is to shift the economics from a fee-for-service environment (ie, buy and bill) to one that rewards quality, efficiency, and a lower cost of care.
A new payment model announced by the US Department of Health & Human Services offers providers the potential to receive at least $160 per month for patients who are undergoing chemotherapy treatment. The per-beneficiary, per-month (PBPM) allocation is part of a 2-pronged approach that also includes a performance-based payment to incentivize practices to reduce costs and improve care for this patient population.
The following sections will assist healthcare professionals and payers by providing appropriate coding and billing information associated with the treatment of multiple myeloma.
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