OBR Daily Commentary

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Don’t Count on Lower Premiums Despite Pandemic-Driven Boon for Insurers

(KHN) July 31, 2020 - Early in the pandemic, insurers expected the costs of treating COVID-19 would vastly increase medical spending. Instead, non-COVID care has plummeted and insurers have pocketed the result.

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William McGivney, PhD (Posted: August 04, 2020)

quotesIt is interesting to see "record profits" for managed care companies in the face of the Covid-19 Pandemic. The referenced article and press releases from the managed care companies tell us what we already know; that health insurer claims payments were substantially lower in the second quarter of 2020 due to fewer surgeries, decreased outpatient visits, canceled doctors’ visits, delayed screenings etc. In some cases, payer profits doubled. While the article focuses on heavily regulated California where premium increases for 2021 are projected to be moderate, one would hope that given the sad irony of the “Payer Pandemic Windfall” so far in 2020, payers will work to truly moderate or eliminate premium increases for 2021. Not so, instead the article reports on a projected premium increase of 13.8% being sought in New York State by one national insurer. Television now has advertisements by car insurance companies emphasizing decreases in rates for 2020 and the return of some premium monies to their subscribers. The referenced article here points out that one national health insurer is providing premium credits and cost-sharing waivers. One would hope that such return of monies would go beyond contractual requirements negotiated by large self-insured employers powerful enough to do so. Then, we filter down to providers who at almost every level (e.g., hospitals, community practices) are losing substantial sums of revenue that remain in the pockets and/or banks of managed care companies. The referenced article indicates the distinct possibility of contentious negotiations between providers and payers for 2021 and beyond. And so it goes, as we battle the most awful and dangerous Pandemic threat to both individual existence and to the existence of our society, we continue to traverse The Road to Kick Ass-Health Care. quotes

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Translated Tool from NCCN Measures Mental Health "Temperature" of People with Cancer

(NCCN) July 13, 2020 - The National Comprehensive Cancer Network® (NCCN®)—an alliance of leading cancer centers in the United States—today announced the NCCN Distress Thermometer has been translated into 46 languages. This free resource helps providers worldwide identify and address the multifactorial aspects of distress cancer patients can experience.

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William McGivney, PhD (Posted: July 19, 2020)

quotesIt is with fondness and a smile that I read the story about the distress thermometer now being available in 46 languages to help manage and improve the psycho-social well-being of patients with cancer. I joined the NCCN as CEO and the fourth employee in January of 1997. The NCCN Guidelines were in an embryonic stage. There was one NCCN doctor who early on saw the tremendous potential of what the NCCN was doing in terms of Guidelines to drive a standard of cancer care. Early on in my NCCN career, I received a call from a psychiatrist at Memorial Sloan Kettering. It was Jimmie Holland MD, the inaugural Psychiatrist-in-Chief at MSK. Dr. Holland cogently put forth and emphasized the need that the psycho-social needs of patients be evaluated and addressed from diagnosis through survivorship. Dr. Holland championed her concept of using “distress” as the encompassing description of a set of characteristics that deserved the attention of clinicians. While gentle and almost “grandmotherly” (in a very good way) in her approach, Dr Holland was indomitable in her drive to provide the best comprehensive care for patients with cancer. Dr. Holland worked with tireless dedication to help to optimize the psycho-social well-being of patients. Indeed, by 1999, she had achieved her goal, in part, with the publication of the NCCN Guideline for the Management of Psychosocial Distress. There were many key NCCN figures who contributed to the attainment of Dr. Holland’s goal. Dr. Holland did not stop there. Now, but twenty years later, the work of Dr. Holland drives the comprehensive care of patients across the globe. I smile remembering a person whom, with great rarity, I describe as a "Saint among us"! Dr. Jimmie Holland died in 2017 at the age of 89. God Bless you Dr. Holland! quotes

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Cancer Care Costs in the United States Are Projected to Exceed $245 Billion by 2030

(AACR) June 10, 2020 - The national cancer-attributable costs in the United States are projected to increase by over 30 percent from 2015 to 2030, corresponding to a total cost of over $245 billion, according to a new study. “Rising health care expenditures are a burden for patients, and costs of cancer care has become a critical topic in patient-provider discussions to facilitate informed decision-making,” said study author Angela Mariotto, PhD, chief of the Data Analytics Branch at the National Cancer Institute (NCI) in Bethesda, Maryland.

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William McGivney, PhD (Posted: June 11, 2020)

quotesThis comment relates to the article described by Mariotto et al that projects that “Based solely on population changes due to aging and growth, the researchers estimate that the national costs for cancer-related medical care and oral prescription drugs in 2030 will be $221 billion and $25 billion, respectively, totaling nearly $246 billion. This represents a total increase in national cost of 34 percent.” Quite frankly, a 34% increase in terms of increase over a 15-year period seemed somewhat tame. It is understood that the projection is based “solely” on population changes. I found a similar analysis done by the same group and published in 2011 in JNCI. This article by Mariotto et al estimated that for the period 2010 through 2020, with a constant incidence and survival and costs of care, Cancer-attributable medical costs would rise by 27%. Again, the 27% percent increase in the total medical costs “reflects growth and aging in the population only”. In this 2011 article, a sensitivity analysis was applied to evaluate the impact of advancing technology (e.g., testing, biologics) and projected that with a 5% annual increase in costs of care, Cancer attributable medical costs would increase by 66% from 2010 to 2020. As such, the application of reasonable “costs of cancer care” factor by the authors is necessary to arrive at a more robust estimation of what can be expected in terms of total increase in the national Cancer-attributable medical costs across defined periods of time. quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Associate Clinical Professor, Medical Oncology Executi...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics Professo...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Steven Spielberg Family Chair in Hematology Oncology P...

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Stephen M. Schleicher, M.D., MBA

Community Oncology, Medical Oncologist, OneOncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Health Policy
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William McGivney, PhD

National Health Policy Expert...