CHICAGO—The purchasers that make critical health care decisions for approximately 75% of the American population who have insurance readily acknowledge they have little understanding of the cost of oncology care or the types of services that cancer patients need.
That is why the American Cancer Society (ACS), in conjunction with the Kerr L. White Institute for Health Services Research, Decatur, Ga, convened a conference on purchasing oncology services, sponsored by the ACS.
“The objective of the conference is to develop recommendations for health care purchasers so they can make more informed decisions when preparing benefits packages,” said Charles B. Cangialose, PhD, vice president and chief operating officer of the Kerr L. White Institute.
Over the last 9 months, he said, the ACS and the Kerr L. White Institute have worked with an unofficial task force, made up of representatives from private and public payers, consumer groups, and oncology providers, to develop content for the conference that would facilitate the development of these recommendations. Dr. Cangialose identified several issues that are being addressed by the task force as they develop their recommendations, which are expected sometime next year.
1. The role of the patient in treatment decisions. The task force must reach consensus on how to involve patients in health care decision-making, particularly when the choice of a treatment may conflict with the health care coverage that is available.
2. Comprehensive oncology benefits. Most members of the task force agree that purchasers should offer comprehensive oncology benefits. Many also suggest, however, that health insurance beneficiaries should be free to choose between comprehensive cancer treatment coverage and other, less inclusive insurance provisions and options.
3. Access to preventive and screening services. The task force needs to decide whether the recommendations for purchasers should specify who will provide prevention and screening—primary care doctors, oncologists, or other specialists in the field.
4. Access to comprehensive treatment. The task force needs to define the scope of comprehensive care as well as the composition of the multidisciplinary team that will provide it.
5. Volume of evidence available. Although task force members are committed to evidence-based decision-making, they still must resolve concerns about the amount and the value of the evidence on oncology services that is currently available, Dr. Cangialose said.
6. Access to clinical trials. There is broad agreement among task force members that investments must be made to obtain the clinical evidence that will be used for decision-making. Questions remain, however, about the degree of scientific rigor with which clinical trials must be conducted to obtain that evidence.
“The challenge here is, what is the domain of clinical trials? Is it purely therapeutic, or should there be trials for certain psychosocial interventions?” Dr. Cangialose said.
Also, there is the question of who will serve as the ultimate arbiter for deciding which clinical trials will be financed by purchasers. “I think everyone agrees that they are prepared to put up resources to promote the development of evidence through clinical trials,” Dr. Cangialose said. “However, the overall issue is, once these resources are in place, what mechanism do you use to allocate those resources for the various research activities that are out there?”
7. Access to appropriate follow-up care. The principal concerns of task force members are, who should provide follow-up care and what is the context for providing this type of care?
8. Access to end-of-life, palliative care. “There is fairly broad agreement among members of the task force that these services are not optimally provided in the current marketplace,” Dr. Cangialose said. “We therefore need to come to some useful recommendations for purchasers so they know what palliative care means.”
9. Reporting on standardized performance measures. It is important for purchasers to support the information infrastructure that is needed to report performance measures. At present, however, the vast majority of health plans have difficulty producing such information. That is why purchasers will need to become proactive in promoting information infrastructure among plans and providers, Dr. Cangialose said.
10. Quality improvement activities. For the most part, task force members agree that the providers of comprehensive cancer care should participate in continuous quality improvement activities. “The question remains, how do we incorporate that into a formal recommendation for purchasers?” he commented.
11. The uninsured. “This is something task force members believe purchasers may have to sidestep,” Dr. Cangialose said. “We have been saying that, as purchasers, we recognize there is a big issue here, but it is an issue that will have to be resolved in the broad political process. It is not something that can be addressed by purchasers.”
12. Infrastructure requirements. Task force members, in their final recommendations, must be sensitive to the infrastructure improvements they will be asking purchasers to make, as well as the ability of the marketplace to respond.
