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By: Tom Huggins

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Thursday, 20-Mar-2014 10:27 Email | Share | Bookmark
Some Of Nation's Best Cancer Hospitals Still Out-of-reach For Pa












Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs. The AP asked the centers how many insurance companies in their state's exchange included them as a network provider. Of the 19 that responded, four reported access through all insurers: the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore; Fox Chase Cancer Center in Philadelphia; Duke Cancer Institute in Durham, N.C.; and Vanderbilt-Ingram Cancer Center in Nashville, Tenn. <br> Some Of Nation's Best Cancer Hospitals Still Out-Of-Reach For Patients, Despite Health Care Law





Relative value health care: Some Obstacles





The most basic problem is that the information necessary to creating relative value ratings is virtually nonexistent. There is no scientific evidence even for the basic effectiveness much of the medical care that is provided every day (even clinical practice guidelines, which seem evidence based, are often based on consensus opinion rather than hard data), much less evidence that compares benefits of treatments to their costs. A huge investment in developing the necessary information would be needed. The good news, however, as that the Affordable Care Act has at least created a framework for this investment. The ACA created the Patient-Centered Outcomes Research Institute (PCORI), a private non-profit organization charged with coordinating comparative effectiveness research (CER) to compare the efficacy of treatments for different medical conditions. The health-care law also provides substantial funding for CER. By combining cost data with comparative effectiveness data, research institutecould provide the relative value ratings needed to facilitate a RVHI market. Although the health-care law prohibits the government from using the results of CER as the basis for insurance coverage mandates quite clearly a response to fears of government death panels there is nothing in the law that prohibits the government from providing cost effectiveness ratings that private parties could then use as the basis for insurance contracts. Even with a structure in place, and assuming the massive funding commitment that would be needed to create relative value ratings, it would surely take many years to create anything like a complete set of relative value ratings. This problem, in itself, is not a substantial impediment to RVHI. Currently accepted treatments would have to be grandfathered into the system with a rating of 1 until relative value ratings could be established, while new treatments and technologies would have to demonstrate their relative value before earning a rating and qualifying to be covered by RVHI policies. Thus, the concept of RVHI would be phased in over time. A second practical problem with RVHI is the risk of adverse selection. Specifically, if only sick people choose deeper policies (which cover less cost effective treatments) and the young and healthy choose cheaper, shallow policies, the selection effect might make deeper policies unsustainable, even for customers who prefer to spend a large chunk of their wealth on health insurance rather than other goods and services. To fight this problem, the law would have to have a mechanism to allow insurers to prevent customers who purchase shallow policies from switching to deeper policies immediately after they are diagnosed with a serious illness. <br> Relative value health care: Some Obstacles



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