The National Academies of Sciences, Engineering, and Medicine | The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care

The National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine hosted a workshop to examine the evidence base on how the Patient Protection and Affordable Care Act has altered the landscape of cancer prevention and care delivery.

Don Berwick, Institute for Healthcare Improvement:
“The Affordable Care Act gives tremendous opportunity for mapping aims for improvement into public action and payment policy and support for innovation.”

Sherry Glied, New York University:
“I see a lot of progress to date, almost extraordinary progress, and lots of opportunities for incremental progress moving forward that will make the Affordable Care Act an even stronger foundation for health insurance coverage in the United States.”

Lori Pierce, American Society of Clinical Oncology:
“There has been undeniable progress on a variety of fronts since the passage of the Affordable Care Act.”

Key Patient Protections in the ACA for People with Cancer

Prohibits exclusions for preexisting conditions.
Subsidies for purchasing insurance through the marketplace for people with incomes above 138 percent of the federal poverty level (FPL) or above 100 percent FPL in some states without Medicaid expansion.
Limits on deductibles and out-of-pocket costs.
Coverage of a minimum set of 10 essential health benefits.
Coverage of preventive services without cost sharing.
Consistent coverage across bronze, silver, gold, and platinum marketplace plans.
Coverage for dependents up to age 26 on a parent’s plan.

Improving Access to High-Quality Cancer Prevention and Care

Expand access to Medicaid to increase the number of people covered by health insurance, especially in states that have not yet adopted Medicaid expansion under the ACA.
(Berwick, Bradley, Fedewa, Glied, Huberfeld, May, Pierce, Riley, Sebelius, Simon, Sabik, White-Johnson)
Move away from fee-for-service models that do not foster quality and continuity of care, and invest in bold redesign of care delivery.
(Berwick, Bradley, Buntin, Glied, McAneny)
Establish clear aims for quality improvement, increase transparency, and implement best practices.
(Berwick)
Broaden the definition of quality cancer care to incorporate what matters most to patients.
(Berwick)
Recognize cancer as a chronic illness, and apply value-based payment initiatives.
(Riley)
Improve coordination across federal agencies around research priorities related to the quality of cancer care.
(Buntin)
Communicate clearly with patients to increase understanding and adherence to screening protocols.
(May)
Enforce regulations to prevent short-term insurance coverage from being sold on a long-term basis, and clearly inform consumers on the type of plan being purchased.
(Fishman, Glied, Keith)
Remove work requirements, limits on retroactive coverage, and other barriers to Medicaid enrollment and coverage.
(Fedewa, Huberfeld, Sebelius)

Nicole Huberfeld, Boston University:
“Medicaid expansion has also improved access to care. It has increased utilization. And importantly, it has improved access to care for populations historically excluded from American health care. It has improved health.”

Cathy J. Bradley, University of Colorado Comprehensive Cancer Center:
“The priority has to be providing a mode of access and insurance to those individuals in states that have not adopted Medicaid expansion.”

Melinda Buntin, Vanderbilt University School of Medicine:
“Cancer patients may face numerous health challenges, so they need to be embedded within larger payment systems and larger demonstrations to make sure that all their care needs are taken care of.”

Trish Riley, National Academy for State Health Policy:
“There is a real need to incorporate cancer into state value-based purchasing initiatives to recognize cancer as a chronic illness and to think about ways in which value-based purchasing can incentivize good cancer care.”

Strengthening Patient and Community Engagement in Cancer Research and Care

Empower patients by asking what matters most to them.
(Berwick)
Identify opportunities to engage with the community to solve problems.
(White-Johnson)
Develop interventions at the levels of the individual, community, and care systems to enhance health insurance coverage and access to care for adolescents and young adult survivors of cancer.
(Park)
Tailor clinical research and streamline regulatory requirements to enable patients to participate easily, and create the infrastructure to integrate trials into the workflow.
(Pierce)
Conduct clinical trials in the community to improve accessibility for patients, and design trials that are meaningful to patients.
(Sigal)

Freddie White-Johnson, Mississippi Network for Cancer Control and Prevention:
“The solution is in the community, and through community engagement we feel like we are doing a very good job in changing lives and saving people from dying prematurely from cancer.”

Ellen V. Sigal, Friends of Cancer Research:
“We particularly have to work on how minority patients are going to be involved in these trials, and to design trials to make it easier.”

Elyse R. Park, Harvard Medical School and Massachusetts General Hospital:
“Interventions are needed at the individual, community, and systems level to improve adolescents’ and young adults’ health insurance literacy and access to care.

Addressing Health Care Costs

Simplify processes that do not add value, such as nonessential administrative tasks.
(Berwick)
Improve care coordination and integration.
(Berwick, Pierce)
Address the high premiums and high out-of-pocket maximums in the marketplace insurance plans.
(Glied)
Make bundled payment models more effective by adjusting payments based on risk and other factors that are out of clinicians’ control.
(McAneny)
Test models for cancer screening and care and scale those found to be effective at the state level.
(Pierce, Sebelius)
Cap out-of-pocket patient costs, and limit drug price increases to the inflation rate.
(Buntin)
Improve reimbursement for patient navigation for patients with cancer.
(Park)
Study cost-sharing loopholes, such as grandfathered plans, to inform policy reform
(Benjamin, Fedewa, Jensen, May, Sabik)

Lori Pierce, American Society of Clinical Oncology:
“When you bring together a community of clinicians, patient navigators, social workers, policy makers, etc., you bring positive change and you lower the cost to the system. Because early detection clearly lowers cancer care costs.”

Don Berwick, Institute for Healthcare Improvement:
“The best way to reduce cost is to coordinate care, to integrate care. Anything we can do to help build integrated health systems in this country will certainly foster better care.”

Addressing Social Determinants of Health to Advance Health Equity

Invest in interventions to address the social determinants of health that influence people’s ability to be healthy and increase their risk of cancer.
(Benjamin, Berwick, Bradley, May, Pierce, Richard, Samuel-Ryals, Sebelius)
Educate community members, political leaders, and others about the importance of research to eliminate health disparities.
(White-Johnson)
Diversify the cancer care workforce to effectively connect with communities affected by health equity issues.
(Jensen)
Link health equity to care quality through accreditation.
(Samuel-Ryals)
Address the social determinants of health through policy reform and by creating partnerships among communities, patients, academics, and medical professionals.
(Samuel-Ryals)
Advance research that examines the effects of racism, both institutionalized and interpersonal, on inequities in cancer care and outcomes.
(Samuel-Ryals)
Link health equity to care quality through payment models.
(Strawbridge)

Georges C. Benjamin, American Public Health Association:
“Health inequities arise by differences in access to preventive, acute, and chronic care. Also differences in the quality of care received within the health care setting, individual differences in approach to health or health care, and differences in social, political, economic, or environmental exposures.”

Cleo A. Samuel-Ryals, University of North Carolina at Chapel Hill:
“We need to align equity as a quality metric with payment and accreditation standards. This is critical to accountability.”

Folasade (Fola) P. May, University of California, Los Angeles:
“Unaddressed social needs like unemployment, unstable living environment, and food insecurity impact our quality of life, access to health care, ability to live in a healthy state, and [people’s] ability to gain access to screening tests and cancer care.”

The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care

Key Patient Protections in the ACA for People with Cancer

Improving Access to High-Quality Cancer Prevention and Care

Strengthening Patient and Community Engagement in Cancer Research and Care

Addressing Health Care Costs

Addressing Social Determinants of Health to Advance Health Equity

Workshop Reels

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