In January, the Association of Community Cancer Centers (ACCC) released results of the “2019 Trending Now in Cancer Care Survey.” This marks the 10th year of the annual ACCC survey, which is designed to identify current and emerging trends for US cancer programs. For the third year in a row, ACCC and the Advisory Board Oncology Roundtable partnered to conduct the survey and collect information on key issues affecting cancer care providers across the country. The survey was distributed via email in the fall of 2019. A total of 144 individuals from 126 organizations responded, with the majority of respondents identifying themselves as cancer center administrators or leaders.
Survey results present a snapshot of pressing challenges for cancer programs and insights on variations in how programs—of all sizes—are prioritizing, planning, and responding to the uncertainties in the US health care system and the rapidly evolving oncology ecosystem.
Payer Reimbursement Requirements Seen as Threat to Growth
In 2019, as in 2018, survey respondents ranked payer reimbursement requirements (49% and 48%, respectively) among the top threats to future cancer program growth. But in the 2019 survey, the shift away from fee-for-service to value-based reimbursement ratcheted up as a threat to program growth, with nearly half of respondents
(48%) naming it as a leading threat to growth compared to 30% of 2018 respondents and 43% of 2017. These shifts may be a reflection of cancer programs’ increasing experience with value-based payment and alternative payment models (APMs). In both the 2019 and 2018 surveys, 40% of respondents named uncertainties in drug pricing reform policies as among the top five threats to cancer program growth.
Value-Based Contracts: Participation Variable
The “2017 Trending Now in Cancer Care Survey” found that one in three cancer programs were not participating in value-based contracts. At that time, of respondent programs engaging in these new reimbursement models, most (40%) were participating through shared savings or accountable care organization (ACO) contracts. Only 24% reported participation in pay-for-performance (including pathways compliance bonus). Results of the 2018 survey revealed a shift. In that survey year, most respondents reported participation in some type of value-based contracts. The most commonly reported were pay-for-performance (including pathways compliance bonus) contracts (29%); followed by ACO/shared savings (28%); the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model (OCM, 23%); and bundled payment, case-rate payment, and/or episode-based payment with private payers, excluding the OCM (17%).
Results from the 2019 survey show cancer program participation in value-based contracts to have shifted once more. For 2019, 31% of respondents reported participation in ACOs/shared savings contracts (down from the high of 40% in 2017, but a slight uptick from 28% in 2018); 20% reported bundled payment, case-rate payment, and/or episode-based payment with private payers, excluding the OCM; 19% reported OCM participation; and 19% reported pay-for-performance contracts (including pathways compliance bonus). With the CMMI’s OCM movement to two-sided risk and the model winding down, these numbers may not be unexpected.
Care Standardization Recognized as Opportunity for Cost Savings
Ranking among the top opportunities for cost savings over the past three surveys is clinical standardization of care (63% and 54% in 2017 and 2018, respectively) and reduction of unwarranted care variation (72% in 2019).
While pathways-specific questions were not included in the 2018 and 2019 surveys, the 2017 ACCC survey report showed moderate use of clinical pathways—the most popular being homegrown pathways, followed by Value Pathways powered by National Comprehensive Cancer Network (NCCN). In the 2017 survey, one in three cancer programs reported having developed and implemented their own clinical pathways for medical oncology (32%) and radiation oncology (30%). One in four reported using Value Pathways powered by NCCN for medical oncology (24%), while only 14% reported using these pathways for radiation oncology. By comparison, in the 2016 survey, 43% of respondents reported developing and following clinical treatment pathways to standardize care.
Telehealth for Oral Chemotherapy Adherence and Support
As approvals and indications for oral agents continue to grow, 43% of 2019 survey respondents include oral chemotherapy adherence and support among the top services they plan to add or expand in the next 12 months. In both 2019 and 2018, more than one-quarter (28%) of survey respondents said their programs planned to provide oral chemotherapy adherence education and support via telehealth in the next 2 years.
Helping Patients Through the Health Care Cost Maze
Cancer programs have increasingly recognized the need to add financial navigation staff to assist patients and families with the economic burden of cancer. The growth in these services is reflected in ACCC’s annual surveys. In the 2017 survey, three of four programs reported having a dedicated financial advocate on staff. When the 2018 survey results were released, programs with dedicated financial advocacy staff had grown to 81%.
Results of the 2019 survey show that 43% of respondents plan to add or grow financial advocacy services in the next 12 months, and 32% ranked financial advocacy staff among the top five staff and/or positions they plan to add in the next 12 months. The scope of financial advocate responsibilities varies and, as reported in a recent article by Gretchen Van Dyck, published in the ACCC 2017 Patient Assistance and Reimbursement Guide, may include monitoring for pathway compliance.1
1. Van Dyck G. Financial counselors: a must have in oncology. https://www.accc-cancer.
=213d0e80_6. Rockville, MD: ACCC 2017 Patient Assistance and Reimbursement Guide; 2017. Accessed January 24, 2020.