High-Quality Cancer Care Focus of ASCO’s Medicaid Reform Recommendations

Rosemary Frei, MSc

March 2015, Vol 6, No 2 - Health Policy


Late last year, the American ­Society of Clinical Oncology (ASCO) issued a policy statement on Medicaid reform, with recommendations on ensuring quality of care for all patients with cancer, including the underserved population, while also improving provider reimbursement to ensure value-based care. ASCO’s poicy statement advocates for the expansion of Medicaid coverage to all Americans with cancer, an increase in Medicaid pay­­ment rates to reach those of Medicare, and a greater emphasis on rewarding providers for the delivery of quality care (Polite BN, et al. J Clin Oncol. 2014;­32:­4162-4167).

“That’s a key take-home point—that you don’t see just us out here saying we want more money to take care of Medicaid patients; we say we are ready to completely rethink the entire way this program is run,” said Blase N. Polite, MD, MPP, Chair of ASCO’s Government Relations Committee, and Assistant Professor of Medicine, University of Chicago, in a news conference in January 2015. “And increased resources in conjunction with us providing better care, and showing value, are really the key driving points of our recommendations.”

ASCO President Peter P. Yu, MD, FACP, Director of Cancer Research, Palo Alto Medical Foundation, CA, agreed that the statement stems from concern for the quality of and access to cancer care.

“We…believe that no individual diagnosed with cancer should be without insurance that guarantees access to high-quality cancer care delivered by a cancer specialist. Therefore, patients with cancer who have Medicaid should receive the same timely and high-quality care as patients with private insurance,” said Dr Yu during the news conference.

“For these and other reasons, ASCO strongly believes that the society should…make concrete, constructive recommendations for strengthening this program to ensure that our most vulnerable citizens receive needed healthcare,” Dr Yu said.

Quality Cancer Care, Removing Barriers

Dr Polite outlined the 5 central points in the recommendations:

  1. Every state should expand its Medicaid program to cover individuals with incomes below the federal poverty level or use another method to ensure that bene­ficiaries have access to comprehensive, subsidized, high-quality cancer care, as measured by cancer-specific quality metrics and delivered by cancer specialists
  2. Medicaid reimbursement levels should be increased to those of Medicare, and oncologists should take the lead in the creation of cancer-related quality measures and payment reforms
  3. State flexibility in running the Medicaid program should be tied to meeting quality metrics
  4. Medicaid should eliminate barriers between current Medicaid enrollees and those who are eligible for Medicaid under the expansion of the program with the Affordable Care Act; it should cover all genetic testing (not just testing for BRCA mutations) without deductibles or copays for all established cancer-related syndromes; and cover risk-reducing therapies, including surgeries and medications, in patients with inherited cancer risk syndromes
  5. Medicaid should cover routine patient care costs associated with participation in approved clinical trials, and should allow patients to cross state lines to participate in such trials.

Accountability

“In exchange for greater flexibility and increased resources, we as physicians are ready to be held accountable for the quality of care we provide our patients,” Dr Polite emphasized. “We believe that states should be willing to do the same in exchange for the flexibility they want to administer the Medicaid program.”

Other recommendations include:

  • Out-of-pocket expenses associated with oral cancer medications should be equal to those for intravenous or injected oncology medications or, alternatively, intravenous and oral therapies and supportive care drugs should be exempt services with respect to cost-sharing
  • The 340B program should be changed to fit its original intent of ensuring care for uninsured and underinsured patients with Medicaid across care settings
  • Medical home designations should be applied to the spectrum of care facilities and providers needed by patients with cancer, including care coordination and patient education by cancer specialists.
“Over the next year, ASCO will work closely with federal and state policymakers to identify viable approaches and ways to meet the needs of patients whose healthcare depends on Medicaid,” said Dr Yu at the conclusion of the news conference.