National Comprehensive Cancer Network

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NCCN Trends™: Are Centers and Practices Implementing Changes to Their Reimbursement / Payment Models?

Jake B. Guinto, PhD, Manager, Oncology Drugs & Biologics

The Affordable Care Act (ACA) is scheduled to go into effect in 2014 with the goal of making health care more accessible. Beginning in October 2013, people in the United States will have the option to enroll for health insurance through state-based health insurance marketplaces (also known as health insurance exchanges). As a result, it is expected that coverage will expand, covering as many as 27 million additional lives by 2016. It is clear that these changes will affect patients, but how will the changes affect current reimbursement and payment models within oncology centers and practices?

To gain a better understanding of how reimbursement models may change within centers or practices, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ Survey in 2012. Respondents included oncology physicians, nurses, surgeons, pharmacists, and other oncology stakeholders from the United States and abroad. The survey focused on the initiation of new payment/reimbursement models with insurers or accountable care organizations (ACOs).

NCCN first asked whether respondents' centers or practices had initiated any new payment/reimbursement models with insurers or ACOs. As shown in Figure 1, 15 percent of respondents answered 'Yes,' with close to half of the respondents answering 'No' (48 percent). Thirty-eight percent of the respondents answered 'N/A – Not applicable.'

For those respondents who answered 'No' to the initiation of new payment/reimbursement models, we asked about the likelihood of their centers or practices incorporating new payment/reimbursement models with insurers or ACOs by the end of 2013. As shown in Figure 2, 24 percent of the respondents were 'Likely' to 'Extremely likely' to incorporate new payment/reimbursement models. Thirty-five percent answered 'Neutral', with 41 percent answering 'Unlikely' to 'Extremely unlikely.'

In summary, for those respondents where the initiation of new payment/reimbursement models apply (those not answering 'N/A – Not applicable'), approximately 24 percent of the respondents have initiated new models with insurers or ACOs. In addition, more practices and centers are planning to initiate changes in 2013, which can be expected with the implementation of the ACA in 2014.  The transition to the changes resulting from health care reform will ultimately depend on how patients and oncology stakeholders adapt.

The ACA and other key topics in oncology will be discussed at the NCCN Academy for Excellence & Leadership in Oncology™ School of Pharmaceutical & Biotech Business in July 2013, at The National Press Club in Washington, DC. One of the five modules,  titled, 'The Affordable Care Act – Communicating the New Normal to Patients: Who Will be Responsible?,' will focus on how patients will be informed of the changes occurring as a result of the ACA and the impact of the ACA on oncology stakeholders.

About NCCN Trends™ Surveys and Data

NCCN Trends™ is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends™ surveys pose questions regarding topics including, but not limited to, patterns of care, and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders.

Data is gathered through brief electronic surveys to more than 200,000 health care providers who access the NCCN website on a frequent basis and express interest in responding to NCCN Trends™ Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also include pharmacists, nurses, and other oncology stakeholders.

To learn more about NCCN Trends™ Surveys and Data, to commission a survey, or to discuss a customized survey, please contact Jake B. Guinto, PhD, Manager, Oncology Drugs & Biologics.

About NCCN Academy for Excellence & Leadership in Oncology™ School of Pharmaceutical & Biotech Business

Through this interactive program, pharmaceutical and biotechnology professionals are given the rare opportunity to view the oncology space, its future, and its current operational issues from the provider and payor perspectives, among others. Present by dynamic experts in the field, NCCN Academy features modules that focus on real-world trends, including policy, coverage, reimbursement, and informational and operational issues in oncology.

Professionals from marketing, sales, medical affairs, clinical research, policy and government affairs, and other business areas within pharmaceutical and biotech industries gather valuable insights in developing effective strategies for navigating the various constituencies in cancer care, and are better able to serve their customers upon completion of this program. NCCN has also made NCCN Academy Video Modules available to license to companies for internal training purposes. For more information regarding NCCN Academy (including a customized Academy curriculum), please contact 866.788.NCCN (6226) or contact Jon Larsen, Manager, Global Business Development.