the jump from the lab to the clinic,
healthcare leaders have to gauge which
service, drug, or procedure to offer. It’s
not easy, and there have been notably
bad calls. Prostate cancer screening and
bone marrow transplants for breast
cancer turned into painful, costly disappointments. Even the efficacy of
early detection is in question.
Today, the landscape is ever more
complex. Providers, payers, and
patients are faced with astronomically expensive new drugs for cancers
such as chronic myeloid leukemia and,
with lung cancer, yet another screening protocol. In addition, new payment schemes are moving the industry
toward the provision of value-based
services and the promotion of population health management. That means
addressing persistent health disparities
that result in higher cancer mortality rates for African-Americans and
Databeganto emergeinthe late 1990s that computed tomography scans could etect early-stage lung can- cer, and patients started lobbying hospitals to offer
the service. Lung cancer is difficult to
catch early and is usually lethal.
But many hospitals are just now
offering the service. Low-dose CT lung
cancer screening looked promising 20
years ago, yet there were enough outstanding questions to keep most payers
from covering it.
What has changed? In 2011, a
long-term randomized clinical trial
produced evidence of a 20% reduction
in mortality for high-risk patients. In
November 2014, the Centers for Medicare & Medicaid Services announced
that it would begin paying for the
scans. Once Medicare moves, private
insurers usually follow.
With the accelerated pace of cancer
research, hospitals and healthcare systems are making decisions every day
about the clinical relevance of research
findings. When new approaches make
>COMPLE TE CARE. Randall F. Holcombe,
MD, is chief medical officer for cancer at
Mount Sinai Health System in New York
City. He says by assembling a multidisciplinary team, the organization’s cancer
institute can better address aspects of
care such as anxiety or comorbidities.
Oncology Care Options
Healthcare leaders are weighing evidence and making decisions on
the value of adopting new cancer services, including low-dose CT
scans, high-priced drugs, and efforts to address comorbidities.
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