Lichter stressed that only by gathering and combining data can progress be made on personalizing cancer care. “Individual institutions cannot sort this out and figure out what works for distinct patient subgroups,” he said. Canetta suggested more sharing of drug data among different pharmaceutical companies. Such sharing would enable greater understanding of which subgroups of patients are most likely to benefit from specific treatments. Data sharing can also be a cost-cutting measure in the drug development arena, for example, if it reveals early radiology endpoints that can be relied on to assess treatment effectiveness, he noted. In addition, precompetitive collaborations in early drug development with companies targeting the same cancer pathways can help to reduce the risks and costs of drug development that are factored into drug prices, Canetta noted.
A number of speakers noted the need for better alignment of financial incentives to reward affordable, high-quality cancer care. Financial incentives can encourage both clinicians and patients to change their behavior and consider costs in decision making. In addition, tying reimbursement to performance on quality metrics could also incentivize affordable, high-quality care.
Provider Financial Incentives
Changes that would alter the financial incentives for providers include more reimbursement for cognitive care, elimination or reduced use of fee-for-service reimbursement, and better reimbursement for coordinated, cost-effective care. Reimbursement levels could also be based on performance metrics.
Peppercorn and others suggested increased reimbursement for clinicians spending more time with their patients discussing their medical intervention options (cognitive care). “If 80 percent of your income was based not on the profit margins from administering chemotherapy, and instead on having a great discussion with your patients, people would be really well informed and I bet we would see large declines in chemotherapy utilization and cost,” he said.
Earle deplored the U.S. fee-for-service system. “The idea of making half of your practice salary off of selling chemotherapy is crazy. There should be rational decisions, not rationing decisions,” he said.