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Over the past two weeks Oncology Solutions has received a number of messages from our clients asking what the election results mean for healthcare and, more specifically, for cancer care. With President-Elect Donald Trump and the Republican congressional majorities in the House and Senate, change is certainly coming to cancer care. In this newsletter we discuss some of the “knowns” and “unknowns” for the immediate future of healthcare policy and how oncology programs should plan for these outcomes.

Affordable Care Act

On November 10, President-Elect Trump updated the “Great Again” website with a post discussing his administration’s priorities within the first 100 days. The message reiterated his campaign promise to immediately repeal and replace the Affordable Care Act (ACA). The administration will have a willing ally in the Republican congressional majority, who have made it clear that they believe the current ACA legislation charts an unsustainable path for premiums, deductibles, and network access. While the timing of legislative action is undetermined, it is broadly believed that some version of “repeal” will pass in early 2017 through use of congressional budgetary mechanisms.

The greater unknown for healthcare is what the second part of “repeal and replace” will entail. President-Elect Trump indicates a desire to keep popular components of the ACA intact, including coverage for pre-existing conditions and the ability for young adults to stay on their parent’s insurance until age 26. He and congressional leadership have also hinted that the eventual replacement will involve some components of the following:

  • Repeal of the individual mandate to purchase healthcare insurance
  • Enhanced use of tax deductions to encourage insurance participation
  • Establish “high risk pools” for those patients with extensive medical expenses who have not maintained continuous coverage
  • Increased flexibility for insurance plans to be sold across state lines and for employees to keep plans as they move between different employers
  • Roll back of Medicaid expansion enabled through the ACA and enhanced state control of Medicaid funding through block grants, Medicaid work requirements, and monthly contributions to premiums

While these guiding principles may shape an eventual ACA replacement, it is not clear how quickly Republicans will reach consensus on a model, whether it will achieve bipartisan support, or how many people may lose coverage as a result of the change.

The Trump Administration’s position on creating a “patient-centered healthcare system that promotes choice, quality, and affordability” means that the movement toward value-based cancer care is as relevant as ever. There will be a continued imperative to track and measure cancer outcomes, cost of care, and the “voice” of the patient.

Medicare Modernization

Per the Trump-Pence transition website, another major priority for the incoming administration is to “Modernize Medicare so that it will be ready for the challenges posed by the coming retirement of the Baby Boom generation.” It is not entirely clear what specific alterations this modernization will include, as the changes advocated for by House Speaker Paul Ryan have not always been consistent with the campaign message. However, if the congressional roadmap offers clues, it may include any of the following:

  • Gradual privatization through movement away from the traditional fee-for-service program to subsidization of commercial insurance for retirees, i.e., “premium support”
  • Three-year shift to a qualifying age of 67 (instead of 65) and requirement for more insurance coverage to be purchased by those with higher incomes
  • Diminished control or dissolution of the Center for Medicare & Medicaid Innovation (as a result of ACA appeal)

Specific policy details remain unclear, but it is increasingly evident that some type of Medicare reform may be packaged with the efforts to repeal the ACA.

Impact on Cancer Care

Repeal of the ACA and reform in the Medicare program may substantially impact the economics of oncology practice, patient access to appropriate care, and the speed at which CMS moves toward pay-for-performance models. These unknowns are compounded by uncertainty surrounding how the new administration will approach hot topics like drug pricing and value-based purchasing, site-neutral hospital payments, and 340B eligibility. Oncology administrators must closely monitor these policy decisions and prepare flexible strategies for mitigating the impact on their programs and patients.

Despite these open questions, there are several “knowns” we believe will continue in oncology over the next four years:

  • Oncology programs will continue to be extremely important to the overall financial health of hospitals and health systems. The success of the oncology service line is increasingly important as hospitals grapple with contracting Medicaid payments and tightening operating margins elsewhere in the organization.
  • The Trump Administration’s position on creating a “patient-centered healthcare system that promotes choice, quality, and affordability” means that the movement toward value-based cancer care is as relevant as ever. There will be a continued imperative to track and measure cancer outcomes, cost of care, and the “voice” of the patient.
  • Patient-centered healthcare will continue to encourage further alignment of hospitals and physicians, creating a full ecosystem of care coordination. This will mean an increased focus on financial partnerships, program development, hospital-physician collaboration, clinical co-management, and establishing distributed outpatient networks.
  • Surrounding the patient with best-practice supportive care services, navigation, survivorship, and data-connectivity is critical for success in a consumer-centric purchasing environment for cancer care.

While there is significant uncertainty regarding 2017, we are confident that these broader trends will continue to shape cancer care in the coming years. Please call us today at 404.836.2000 or email us at [email protected] and let our team of experts assist you with positioning your program for success.

Author Chartis Oncology Solutions

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