Oncology is one of the most exciting fields in medicine today. Diseases which were incurable a few years ago can be cured with the use of new technologies, treatment options and therapies. Our insight into how cancer cells work and how we can manipulate their genetics, proteins, communication, blood supply, and interactions has exponentially grown over the last decade.
And yet, this great achievement of mankind comes with its side-effects and consequences. One of the biggest challenges of health care is how to control and manage the spiraling costs of drugs and therapies. These threaten to wipe out Medicare funds, individual holdings, insurers, and employers. Previous attempts to control costs through legislation on the price of drugs have been half-hearted, more ostensible than tangible. Any overhaul of Medicare and Medicaid models of payment along with new initiative like Oncology Care Management (OCM) and Extended Oncology Model (EOM) have been minimally effective in reducing the ballooning cost of care.
A modified approach is needed. Some of the following suggestions might help us approach the problem differently and more constructively:
1) Oncologists need to be involved in a concerted initiative to reduce costs along with primary care physicians and other specialists, like surgeons, gastroenterologists, urologists, hospitalists, SNFists, and so on. A top-down approach or management by third parties who wish to use protocols to control costs will only be partially effective. A holistic approach that rewards conscientious providers focused on quality and compliance is the key. Any successful model will necessarily involve intense teamwork and communication between the patient, primary care, oncologists, and other specialists.
2) Alignment of incentives is critical in evidence-based medicine, patient safety, empowerment, and engagement. In addition, alternate and complementary approaches to treatment may be offered and utilized in accordance with patient preference and choice.
3) Models based solely on fear or greed are counterproductive in health care. Pharmaceutical or hospital-chain profits and venality need to be curtailed aggressively and on a wider scale. A skewed or stressed relationship between Big Pharma and Small Provider will in the end hurt the patient.
4) Profits need to be shared or apportioned based on compliance, quality, medical necessity, and appropriateness. Metrics such as CAHPS, HOS, Hedis, Star Ratings need to be used to monitor the practice of oncology. Quality of care with special focus on patient education, support for the indigent population, and end-of-life care and palliative options will be part of a more integral medical paradigm.
5) A larger association such as Value Based Organizations might help due to its ability to focus solely on quality for the larger population. These organizations may contract and align with payers, insurers, large employers, etc. and closely document, record, analyze and review the clinical data and metrics of patient care.
6) The price of drugs needs to be reduced drastically. The Federal Government needs to act expeditiously. The setting up of larger groups and Joint Ventures to aid in the purchasing power of providers needs to be facilitated and made easier through legislation. The exponential increase in oncology costs is a challenge for the entire nation and Medicare Fund.
7) Protocol-based approaches have limited efficacy. Patient and health care advocates will be needed from among the physicians who understand the challenge acute and experientially.
8) Oncology treatments need to look beyond pharmacology or radiation and look at the overall wellbeing of the patient, including their nutrition, immunity, activity, and Social Determinants of Health.
9) Research into the causes of cancer with a truly scientific approach is needed away from interest groups, lobbyists and the Big Pharma and Food industry.
The breakthroughs in Oncology Care are one of the greatest achievements of science and medicine. To apply them on a wider scale and make them available to everyone will need more than skill and knowledge. It will require integrative wisdom and holistic thinking that transcends reductionistic models.
