Policy-Setting and Decision-Making in Oncology or How NOT to Drown in a Sea of Buzzwords!

1. Policy-Setting and Decision-Making in Oncology or How NOT to Drown in a Sea of Buzzwords! Bill McGivney, Ph.D. Principal, McGivney Global Advisors April 11, 2014 mcgivney.wt@gmail.com

2. Tonight a cranky 61 year old cynical Republican and Tomorrow a laid-back 62 year old harmonious Democrat. The wonders of becoming social security eligible!

3. A Few Edits from the Cutting Room Floor

4. US Cancer Care Delivery System: Ever Feel as if You are Working in One Big, Continuous Pilot Project and/or have the Pilot Projectitis Virus?

5. Remember when we used to have health insurance companies? but Health Insurance (Assumers of Risk)  Distributors of Risk Hey Docs: Want some? Come and Get it!

6. Whatever Happened to Managed Care Companies? Hey Docs; You care (treat), you manage, you take the risk WE’llshare in the savings

7. Managed Care Companies  Information Companies (see the money in data: your data)

8. Make the Move away from FFS with the Buy and Bill Overlay to Pay for Performance: Management Fee, Compliance Target (80%), Shared $avings and Episode-Based (Commercial) or Bundled (Medicare) Payment Methods is The Death Knell for New Innovative Health Care Technologies?

9. Coming in 2015! “On the Road to Kick Ass Health Care”: Remind you of Anybody in Florida

10. Patient Cost Sharing: A True Kick Ass Anathema To the Patient: “I am sorry to say that your diagnosis is metastatic non small cell lung cancer. In this world of ‘choice’ in cancer care and shared decision-making in cancer treatment let’s discuss your choices first with respect to your plan’s cost-sharing options”

11. Define Value: Has not every one in health care in the United States defined “Value” in a presentation or a publication yet? I still see white papers that say we need a national committee to define value: “The clinical/patient benefit obtained for a specified expenditure of health care dollars.’ There I am done!

12. Who Defines Acceptable Value and How? “NICE Under Fire For Veto of Eleven New Cancer Drugs” (UK Daily Mail Headline on September 27, 2013) Prime Minister will announce budget for Cancer Drugs Fund Since 2007 NICE has recommended only 31 % of New Medicines Growing calls for “slow” and “unfair” body to be reformed

13. Innovation Spurned: Survival Suffers UK Survival Rate Worse Than European Average for 9 of 10 Cancers (UK Daily Mail Headline, Dec. 4, 2013)

14. Speaking atthe Institute of Medicine every 5 Years (only at their invitation) A Paradigm for Cost-Effectiveness Analysis: “Mind Numbing, it will never see the light of day!”

15. Does “not so NICE” come to the United States? Risk sharing between Biopharma companies and Payers/Managed Care Companies

16. Thesaurausfor Oncology ICD 10 340 B ASP + 4.3% 40% SS PCMH ACO IDN HCP COI

17. COI Requirements HCP Reporting and my Vast Clinical Experience!

18. Big Data: Are oncologistsbecoming obsolete; Can one Oncologist replace you?

19. Are you becoming obsolete; Can one Oncologist replace you? Meet Dr. Watson, a Med Onc Fellow at multiple institutions in combination with Management of some tumor types by primary care docs?

20. Pathways: The Road to Restriction

21. NCCN Needs to Maintain its Influence (“50 Lane Highway”)

22. On the Road to Personalized/Precision Medicine, Not So Fast Now! Medicare and Molecular Testing Reimbursement Coverage

23. Dissociation: There has been a gradual dissociation of the relationship and alliance between biopharma and oncologists. This has occurred while stakeholders hedge their bets mainly to work more closely with managed care companies. The dissociation of the alliance between biopharma and oncologists is not a good thing for either side.

24. When the call comes from the Executive Floor of a managed care company to Medical Management

25. Two of My Managed Care Commandments: Have Policy-Setting processes that you can live with if the beneficiary/patient is your mother, wife, brother, daughter etc.! In close call always err on the side of the patient!

26. Value in the Eye of the BeholderWhen Physician Policy Maker Becomes Patient “I had come into the presence of a technological marvel, namely me. To be sure, the pacemaker is a wonderful miniature piece of high technology, my friend the surgeon a skilled worker in high technology, but the greatest of wonders is my own pump, my myocardium, capable of accepting electronic instructions from that small black box and doing exactly what it is told……………… I suppose I should be feeling guilty about this. In a way I do, for I have written and lectured in the past about medicine’s excessive dependence on technology in general and the resultant escalation in the cost of health care.

27. Value in the Eye of the BeholderWhen Physician Policy Maker Becomes Patient Lewis Thomas, MD: I have been critical of what I have called “halfway technologies” designed to shore things up and keep flawed organs functioning beyond their appointed time. And here I am, enjoying precisely this sort of technology, eating my own words.” 

28. Oncology March Madness Whew! I feel so much better and more harmonious! I am ready to turn 62!

29. Policy-Setting and Decision-Making in Oncology or How NOT to Drown in a Sea of Buzzwords! Bill McGivney, Ph.D. Principal, McGivney Global Advisors April 11, 2014 mcgivney.wt@gmail.com