Patients Rising live blogging Cost Drivers in Cancer Care Webinar

LIVE BLOGGING from Cost of Cancer Care Drivers Webinar:

A Milliman study released recently by the Community Oncology Alliance shows that over the last decade the total costs of treating patients with cancer in the United States have risen no faster than overall costs for Medicare and commercially insured populations. Contrary to a commonly held misbelief that cancer care costs have rapidly outpaced other health care spending trends, the study actually found that total costs of treating patients with cancer have increased at essentially the same rate as all health care spending since 2004.

Why Conduct the Study?

So we can better understand the complete picture of what is really driving cancer care costs?

There is a lot of media attention and this will help us see the hype vs. data.

The data sources 2004-2014, Medicare 5% sample and Truven Health Analytics MarketScan commerical claims data base.

Three Major Findings:

Total cancer care costs are not increasing any faster than overall medical costs for both medicare and commerical populations

Drugs are the fastest growing component of cancer care costs but those are offset by a decrease in other areas (ie. hospitalizations and cancer surgeries)

Where cancer is delivered has a major impact on the cost drivers.

Cancer Prevelance Increase

In the Medicare population there was a 16% increase in the past decade.

In the commerical population there was a 26% increase in the past decade.

Cancer & Overall Costs Increasing at Similar Rates

The major finding here is that the increase in costs is proportional with overall total health care spending.  Cancer cost does increase but debunks the myth that cancer costs are rising at a rate that is disproportional.

*** The total spending for cancer patients has INCREASED LESS than the prevelance of cancer. ***


Component Cost Drivers Present a More Complex Picture Than Just Drugs

Chemotherapy spending has increased from 15% to 18% in medicare and 15% to 20% in commerical population.

Biologics spending has increased from 3% to 9% in medicare and 2% to 7% in the commerical population.

There has been an DECREASE in hospital inpatient admissions and cancer surgeries.

This is important as we beat the drum of drug costs are too high.  The data simply does not support that it is the driver of health costs, though we know patients are taking on more of that burden with high copays and premiums.

Biologic Therapy

Biologic therapies have increased significantly 335% in Medicare and 485% in Commerical.  Oncologists will tell you that getting the right patient the right treatmenrt right now has been the greatest innovation in the last decade and that is seen in this number. Blood cancer patients have seen a significant benefit in innovation.

340B Trends and Hospital Outpatient

Hospitals are simply a higher cost site of service for both the Medicare and commerical population.  As cancer care gets more consolidated in hospitals the cost of care increases overall.

*** The site of service alone added a $2 billion INCREASE in cost of care.  ***

Take Aways

Increasing prices of cancer drugs are a real problem, but not the main focus of ALL cancer costs as we hear daily from the media and academics.

12:44pm:  What does this study mean to payers?

The data speaks for itself. Costs increase for patients when the care moves to the hospital setting.

12:46pm:  What is the impact on site of care shift on access?

40% of community practices have closed. Some have had to join hospitals to stay afloat and when that happens their cost of care automatically increases because of the hospital affiliation. These cost increases fall onto not just the payer, but the patient.

Why this matters for the Medicare Part B Drug Payment Demo?

Medicare Part B is solely focused on drug reimbursement costs as opposed to the site of service and other components of the care. Quite frankly, the implementation of Medicare Part B payment demo would potentially put more private oncology practices out of business the cost of care would increase.

When we talk about hospital outpatient vs. community.  How does a major center like MD Anderson fit into this?

If you compare MD Anderson or Memorial Sloan Kettering they are the highest tier of cancer care costs. These institutions are great to have when you need an expertise not available in the community.  However, given how quickly information travels today — most of the time patients can be treated in the community by a community specialists in their cancer type.

What Patients Need to KNow About this Study?

BOTTOMLINE: The newspaper headlines are telling us drugs are expensive and rising. And they are. Innovation is on the rise, and that is a good thing for patients. But many components of cancer care are involved in costs and to look at one part of that is to do a disservice to creating quality care for patients. At Patients Rising we know patients are feeling the burden of medical cost increases in their premiums and copays which often fall on their pharmacy bill.

As we look at streamlining the system and adding the value component — we need to look at the value of everything involved in patient care and work towards getting all patients the right treatment, right now.

Moderated By:

Don Sharpe
President, OBR


Debra Patt, MD, MPH, MBA
Director of Public Policy and Practicing Medical Oncologist
Texas Oncology
Austin, TX
David Eagle, MD
Past President, Community Oncology Alliance
Physician, Lake Norman Oncology
Mooresville, North Carolina
Ted Okon, MBA
Executive Director
Community Oncology Alliance

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