WASHINGTON--Caring for patients and conducting research in the age of managed care raises tough problems for all involved, said Peter Quesenberry, MD, director, University of Massachusetts Cancer Center, Worcester. "How can we assure access to treatment, support research, and still be cost effective?"
A panel of oncologists and health plan representatives aired those issues at a forum jointly sponsored by the Leukemia Society of America, American Society for Blood and Marrow Transplantation (ASBMT), and University of Massachusetts Medical School.
"To me," Dr. Quesenberry said, "the most significant worry in the managed care arena is an intolerance for up front costs." A bone marrow transplant, he said, may cost a quarter million dollars, but the long-term survival brings the cost per year of extra life down to $10,000--a highly cost-effective rate.
Insurers say they will cover newer procedures, such as transplants, that meet accepted standards of care or are supported by evidence of outcomes research. "When a treatment reaches National Cancer Institute Level III trial, it's no longer considered investigational, and we would pay for it," said Wendy E.J. MacLeod, MD, FAAP, of Blue Cross/Blue Shield of North Carolina. "Our problem is with unsupervised use of investigational therapies."
"But what about new research?" countered Patrick Beatty, MD, of the University of Utah. "How do you get outcomes if nothing's covered until proven? How do you make that first jump?"
Research support is not the primary concern of the managed care industry, said Joel M. Kaufman, MD, medical director, Fallon Community Health Plan, Worcester. "Employers pay for health insurance, not for research," he said, adding that a researcher who wants an insurer to cover a therapy of uncertain safety or efficacy "is asking a lot."
"It may be asking a lot, but it's the only thing to ask," replied Joseph V. Simone, MD, physician-in-chief, Memorial Sloan-Kettering Cancer Center. "How are you going to move the field forward without trying something new?"