Why Cancer Care Is Different

Cancer Care Is Fundamentally Different From Primary Care

Our health care systems, therefore, should not be structured in the same ways. Nor should incentive systems and reimbursement models.

Here’s why:

  • Primary care is increasingly well-managed through a ‘population health model’ using standardized care guidelines in which care can be delivered efficiently, and at lower costs, to large populations. Cancer care is different. It is increasingly reliant upon genetic and genomic testing to direct care for an individual patient. There is a growing understanding that there are hundreds of different cancer types; each potentially requiring different types of therapy. And yet, tragically, many community oncologists simply are unable to keep up with the pace of innovation in cancer care. A recent survey1 of medical oncologists, for instance, found that 86% of respondents said more physician education is needed before genetic testing could be made widely available.
  • Many health plans’ narrow networks lack adequate physician and health-system expertise to manage today’s increasingly complex population of cancer patients. Given the nature of delegated-risk medical groups whose purpose is to deliver quality primary and secondary care, it is largely impossible to cluster the necessary panel of oncology experts within a particular medical group that can provide the required expert care. Medical groups that take full risk for the cost care are unprepared and at times unwilling to assume the full cost of delivering best-practice care to patients due to their own adverse financial risk.
  • The best chance of a cure is the first chance of a cure: cancer survival uniquely relies on the accuracy of initial diagnosis, choice of therapy, and access to appropriate clinical trials.
  • Medical groups may not contract with expert cancer centers to avoid disproportionately attracting patients already diagnosed with cancer, leading to potentially significant financial risk to the medical group.  Yet, if all plans and medical groups contracted with expert cancer centers this problem could be eliminated.
  • Medi-Cal is failing Californians with cancer. According to research by UC Davis, Medi-Cal beneficiaries have lower survival rates for several type of cancer than those with commercial insurance or other types insurance.

1 Genomic Testing and Precision Medicine in Cancer Care H. Jack West, MD; Gabriel Miller | May 2, 2017 in Medscape Oncology