OBR Daily Commentary

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Offering a Pay-for-Performance Program to Oncology Practices Increases Prescriptions of Evidence-based Cancer Drugs

(Penn Medicine) Oct 7, 2020 - A pay-for performance program that offers enhanced reimbursement to oncology practices for prescribing high-quality, evidence-based cancer drugs increased use of these drugs without significantly changing total spending on care, Penn Medicine researchers report in a new study published online today in the Journal of Clinical Oncology. This is the first study to demonstrate how a national insurer’s voluntary pay-for-performance program can successfully change prescribing patterns among oncologists to deliver higher-quality cancer care.

Bruce Pyenson (Posted: October 09, 2020)

quotesThank you very much, Bill. I'm reminded of the time in the early 2000s, when I was in a meeting with a rather prominent academic economist, one of whom just proudly received a grant to write a peer reviewed publication on how commercial insurance companies set their rates. I felt like telling him (or his sponsor) he could just read the presentations from recent Society of Actuaries meetings. I'm not sure the piece was ever published.quotes

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Offering a Pay-for-Performance Program to Oncology Practices Increases Prescriptions of Evidence-based Cancer Drugs

(Penn Medicine) Oct 7, 2020 - A pay-for performance program that offers enhanced reimbursement to oncology practices for prescribing high-quality, evidence-based cancer drugs increased use of these drugs without significantly changing total spending on care, Penn Medicine researchers report in a new study published online today in the Journal of Clinical Oncology. This is the first study to demonstrate how a national insurer’s voluntary pay-for-performance program can successfully change prescribing patterns among oncologists to deliver higher-quality cancer care.

William McGivney, PhD (Posted: October 08, 2020)

quotes It is always moderately entertaining to read the press releases associated with economic/health policy studies, especially when a “Medical Ethics” perspective is front and center in summarizing the study and its possible applications. In the present example, the bottom-line results of the highlighted insurance company Pay for Performance program as published in the Oct 7 issue of the Journal of Clinical Oncology are: 1. Increase in “evidence-based” prescribing by 5.1% up to 62.2%; 2. Increase in cancer drug spending by $3,339 to $51,369 per patient = 7% increase 3. Increase in patient-out-of-pocket spending by $253 to $2470 (11.4%) “a small but statistically significant amount”. Sounds like just what an insurance company exec would want to hear as the results of a much-criticized, much-maligned program seeking to substantially circumscribe the therapeutic options of medical oncologists. After four years, the program pushed up evidence-based (whose evidence-based?) prescribing by 5.1%. But for example, the PD-1/PD-L1 choice in NSCLC was limited to one PD-1, a truly effective biologic, but there certainly are others. Accompanying that 5.1% increase vis a vis the limited options made available, was a 7% increase in cancer drug spending. And for patients, as the quote says, “a small but statistically significant amount” for the 11.4% increase (i.e., $253) in patient out-of-pocket spending. Ouch, on that statistically significant amount. An 11.4% increase characterized as “small”! Raises in Medical Ethics departments must be pretty good these days and probably with a lot less stress than most of us experience. In the press release, a concluding quote reads: “This program is a much-needed example of an effective program - one that improved the quality of care for patients. As we look forward, we need to build on the success of this program to design programs that also decrease costs.” Sounds like a grant proposal will be forthcoming! Reminds me of another story from years and years ago when I was asked to review a grant proposal for over $400k to understand how coverage decisions were made. I was at Aetna at the time; my recommendation on the grant proposal was “Call me, we can talk for an hour for free, I will explain, you can save a lot of money”. Of course, I was never asked by that well-known agency to review another grant proposal again! By the way, I never saw any specific Quality of Care results in this published article; I guess those such results are alluded to only in the Press Release! One final note is that the Advisor Medical Oncologists are never named only their affiliated institution. I wonder how happy the named institutions would be to have to abide by the drugs/biologics regimens specified in the “Evidence-based" Program? Anybody ever hear of the NCCN? quotes

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Opdivo (nivolumab) Plus Chemotherapy Shows Statistically Significant Improvement in Pathologic Complete Response as Neoadjuvant Treatment of Resectable Non-Small Cell Lung Cancer in Phase 3 CheckMate -816 Trial

(BMS) Oct 7, 2020 - Bristol Myers Squibb today announced that the Phase 3 CheckMate -816 trial met a primary endpoint of pathologic complete response (pCR) in resectable non-small cell lung cancer (NSCLC). In the trial, significantly more patients treated with Opdivo (nivolumab) plus chemotherapy before surgery showed no evidence of cancer cells in their resected tissue compared to those treated with chemotherapy alone. CheckMate -816 is the first and only Phase 3 trial to demonstrate a benefit with an immune checkpoint inhibitor in combination with chemotherapy as a neoadjuvant treatment in non-metastatic NSCLC.

H. Jack West, MD (Posted: October 07, 2020)

quotesThis result represents an important milestone, but we need to see the data to get a clearer picture of the benefit. More importantly, I'd say, we should remember that pathologic complete response (pCR) rate isn't established as highly correlated with overall survival in the setting of early stage NSCLC. I think this approach should not be considered as a new standard of care based on pCR results, in the absence of overall survival data.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...