Payer reimbursement requirements, uncertainties in reform policy, and cost of new treatments viewed as top threats
At a time of unprecedented advances in the science of cancer, growing complexity in cancer treatments, and ongoing health policy fluctuation, the Association of Community Cancer Centers (ACCC) ninth annual Trending Now in Cancer Care survey reveals how cancer programs across the country are being impacted by pressure from turbulence in multiple sectors: payers, government, and industry. The survey conducted in partnership with the Oncology Roundtable was carried out in July and August 2018 and received more than 200 responses.
Top Threats & Opportunities
Ranking the top threats to future cancer program growth, survey responses give nearly equal weight to barriers from three sectors: nearly half (48 percent) name reimbursement requirements from payers, 48 percent cite cost of drugs and/or new treatment modalities, and 40 percent find uncertainties in drug pricing reform policies a top threat.
"ACCC's Trending Now in Cancer Care survey provides much-needed perspective on strengths and challenges experienced by cancer programs across the country," said ACCC President Tom Gallo, MS, MDA. "Despite the barriers and pressures programs face, survey results show continued progress in delivery of patient-centered cancer care."
Respondents' selections for top opportunities for return on investment (ROI) are often the areas of focus for improving patient-centered care delivery:
- Care coordination (45 percent)
- More sub-specialists (44 percent)
- Symptom management (36 percent)
- Screening services (30 percent).
Respondents list symptom management (54 percent) and care coordination (41 percent) among the top five opportunities for cost savings. Translation: Proactive symptom management and improved communication between care settings can help cancer programs and practices keep patients out of the emergency room and reduce unnecessary hospitalizations—simultaneously cutting costs and improving the patient experience
Technology: Burden & Boon
Results of the 2018 survey show that the promise of electronic health records (EHRs) for streamlined communication and increased efficiency remains unrealized. While 69 percent of respondents report their EHRs either "significantly improved" or "somewhat improved" care coordination, nearly 70 percent say EHRs have made physician and staff workdays longer. Almost half (49 percent) feel that EHRs have had a negative impact on provider-patient interactions.
At the same time, telehealth is establishing a foothold in cancer care. Among respondents, 35 percent use telehealth for genetic counseling, 20 percent for oral chemotherapy adherence education and support, and 19 percent for symptom management consults. In the next two years, 33 percent say they will integrate telehealth for survivorship visits, 29 percent for genetic counseling, and 28 percent for oral chemotherapy adherence education and support. Telehealth would also help address one of the major barriers to access to care—transportation. More than two-thirds of survey respondents (67 percent) said they partner with an organization to provide transportation for patients, with another 37 percent implementing their own transportation program to ensure patients can get to their treatment visits. Leading barriers to expansion of telehealth are reimbursement (70 percent) and operational challenges such as staffing or technology requirements (64 percent).
Concern Over Patient Financial Burden Continues
Most responding cancer programs (79 percent) report being "very concerned" or "somewhat concerned" about cancer patients refusing treatment due to financial worries; nearly half (49 percent) say they have had a cancer patient refuse treatment because of financial worries in the past 12 months. The 2018 survey shows cancer programs working to reduce patient financial distress; 81 percent have dedicated financial advocacy staff to help patients and families address economic barriers to care.
While precision medicine is the future of cancer treatment and offers the promise of improved patient outcomes, cancer care providers face numerous challenges to delivering this type of care to their patients. For example, targeted therapies and immunotherapies for cancer increasingly require biomarker testing, yet survey respondents say that barriers such as insurance coverage (68 percent) and payer reimbursement requirements (63 percent) hinder their ability to conduct biomarker testing. Nearly three-fourths (72 percent) of respondents report that cost and reimbursement are the greatest challenges to offering immunotherapy treatments.
"The data provided in this survey is a launchpad for ACCC throughout the year as we develop programs and resources to meet member needs and respond to changes in the healthcare environment," said Gallo.