The landscape and potential for an alternative care delivery and payment model in medical oncology changed substantially in February when CMS rolled out its oncology care model. Meanwhile, Congress is helping physicians who want to participate in alternative approaches. Insurers keep close watch.
Managed Care contributor Richard Mark Kirkner was diagnosed with grade 1 prostate cancer in December 2014. His surgeon talked him out of surgery and he entered active surveillance in April when results of a baseline pelvic MRI graded the lesion stage 2. More men are choosing active surveillance.
The American age-adjusted incidence rate for prostate cancer peaked in 1992 at 237.4 per 100,000 men with the advent of widespread PSA screening and has been falling fast ever since.
Aetna’s national medical director for oncology says that, “we don’t know how to value that. We don’t know how to reward that.” The system will need to change the way to reward innovation by, for instance, “using real market forces to promote competition of price for a class of agents.”
James C. Robinson
Designed to pay for breakthroughs, the new technology add-on (NTAP) ‘bump’ is also too unpredictable, say drug and device groups.
Childhood cancer hasn’t been a big money maker. A not-for-profit helped fund the research that led to the approval of a new drug for neuroblastoma.
"Arterial kateter (Seldinger)" by Privatarchiv Foto von MrArifnajafov