THE 2013 GENENTECH ONCOLOGY TREND REPORT

Transcription

1 THE 2013 GENENTECH ONCOLOGY TREND REPORT Perspectives From Managed Care, Specialty Pharmacy Providers, Oncologists, Practice Managers, and Employers 2013 Genentech, South San Francisco, CA December 2013 Mission Statement The mission of The 2013 Genentech Oncology Trend Report: Perspectives From Managed Care, Specialty Pharmacy Providers, Oncologists, Practice Managers, and Employers is to provide timely and useful information on the latest cancer care trends and developments. Updated annually, the publication is designed to serve as a unique resource for those seeking an understanding of the issues surrounding cancer management and practice. The content of this report was prepared by Emron with the guidance of an editorial board and is based on primary research of key stakeholders, as well as published literature. Statements and opinions contained in this report do not necessarily reflect the opinions of Genentech. 2 1

2 Current Edition The 2013 Genentech Oncology Trend Report Includes a number of longitudinal analyses of trends since the inception of the publication Uses information from secondary resources in each chapter to support survey findings Added new questions to each of the surveys to capture stakeholders evolving strategies related to the following Cancer drug shortages Oncology practice consolidations Risk-sharing and integrated payer/provider initiatives End-of-life and palliative care Site-of-service management 3 Sample Size and Demographics Survey group N Region Other Details Managed care organizations (MCOs) Specialty pharmacy providers (SPPs) Oncologists 159 Oncology practice managers (OPMs) 100 Employers 101 National: 19% Regional/state: 81% National: 91% Regional: 9% NE: 24% W: 23% MW: 19% S: 35% NE: 27% W: 16% MW: 20% S: 37% Average # members Medical benefit: 2.8 million Pharmacy benefit: 2.6 million Ownership 9 PBMs; 4 Independents; 2 Health delivery systems; 6 Other Community practice: 52% Academic/medical center: 31% Hospital-based: 17% Community practice: 58% Hospital-based: 28% Academic/medical center: 12% Government institution/clinic: 2% # Employees Status National: 35% Regional: 65% a : 30% FT: 82% >500: 70% PT: 18% a State-level organizations are considered part of the applicable region. 4 2

3 Key Themes Across Stakeholder Groups Cancer Drug Management Efforts Payer & SPP cancer drug management Integrated payer/provider initiatives Guidelines & pathways Pay-for-performance programs Cancer Drug Spending & Revenue Payer cancer drug spending Oncology practice cancer drug purchasing & revenue Mandatory use of SPPs Coverage & Access to Cancer Drugs Impact of cost sharing on patients & practices Drug shortages SPPs & cancer drug access Oncology Practice Consolidation, Workload & Staffing Practice consolidation Trend toward hospital-based oncology care Oncologist workload Advanced practice clinicians End-of-Life & Palliative Care Cancer Survivorship Care Pharmacogenomics Disease Management Health Information Technology 5 Cancer Drug Management Efforts Payer cancer drug management SPP cancer drug management Integrated payer/provider initiatives Guidelines & pathways Pay-for-performance programs 6 3

4 Payer Cancer Drug Management MCOs rated closed specialty pharmacy networks as their most effective means of controlling cancer drug costs Percentage of MCOs Effectiveness rating Prior authorization protocols 89.1% 3.30 Drug quantity/days supply limitations 81.2% 3.16 Member cost sharing via dollar copays and percent coinsurance 67.3% 2.75 Adjusted drug reimbursement to lower expenditures 56.4% 3.25 Step therapy 55.4% 3.30 Closed specialty pharmacy network 52.5% 3.38 Specialty drug benefit design recommendations 40.6% 2.90 Preferred drug therapy 39.6% 2.83 Limited first fill (ie, short fill) 33.7% SPP Cancer Drug Management The three most effective strategies for cancer drug cost control reported by surveyed SPPs 1 Promoting the use of preferred drugs 42.9% % Creating value through compliance/ persistency programs % Negotiating with manufacturers for better pricing 8 4

5 Integrated Payer/Provider Initiatives Nearly half of MCOs reported pursuing new integrated payer/provider initiatives with oncologists to improve cancer care, such as Forming an oncology accountable care organization (ACO) New risk-sharing arrangements/payment models The percentage of oncology practice revenue tied to global payment arrangements has been increasing steadily over the past 3 study periods, as has the percentage of practices negotiating such an arrangement 7.4% of practices in % of practices in % of practices in Integrated Payer/Provider Initiatives (cont.) In 2012, only 1.9% of surveyed oncologists and 3.0% of surveyed OPMs reported that their practices are currently moving forward with partners to organize an accountable care organizations (ACOs) Oncologists (N=159) OPMs (N=100) Not on our radar screen Trying to understand the regulations Currently investigating Monitoring the experiences of other practices* Do not know Moving forward with partners to organize 10 5

6 Guidelines & Pathways MCOs 72.3% of MCOs reported current or planned guideline/pathway use (up from 65.6% last study period) 29.0% tie incentives to voluntary use 11.6% tie oncologist reimbursement to mandatory use About half of MCOs rated their guideline/pathway use as slightly or moderately effective in enabling quality, cost-effective care Not at all effective Slightly effective Moderately effective Very effective Extremely effective Still measuring program impact Unsure/do not know 11 Guidelines & Pathways Oncologists & SPPs 69.8% of surveyed oncologists reported using cancer treatment guidelines/pathways in 2012 (up from 59.5% in 2009) 24.3% of oncologists have contracts with payers whereby their reimbursement is tied to specific guideline/pathway use Two-thirds of SPPs reported supporting oncologist guideline/pathway use in 2012 (up from one-third in 2011) 12 6

7 Coverage & Access to Oncology Drugs Impact of cost sharing on patients & practices Drug shortages 13 Impact of Cost Sharing on Patients & Practices Cancer drug cost-sharing requirements continue to increase and to affect a larger share of members under the pharmacy benefit (vs the medical benefit) 55.4% of surveyed MCOs do not currently align cost sharing across medical and pharmacy benefits Most common member cost sharing for oncology agents in 2012 Ranges appear in parentheses Medical benefit Pharmacy benefit Mean fixeddollar copay $76.90 ($5 $250) $56.38 ($5 $250) Commercial Mean coinsurance 18.4% (0% 30%) 19.6% (0% 50%) Managed Medicare Mean fixeddollar copay $36.50 ($0 $75) $45.94 ($3 $100) Mean coinsurance 20.6% (0% 33%) 27.5% (10% 35%) 14 7

8 Impact of Cost Sharing on Patients & Practices (cont.) In 2012, OPMs reported that they collected the entire share of cancer drug out-of-pocket payments from only 29.6% of their patients 46.3% of surveyed practices sought financial assistance from charitable organizations for their patients in % of patients were eligible for help from manufacturer assistance programs, with an average 58.8% success rate Share of patient s drug cost share collected (N=95) (N=100) (N=100) 15 Drug Shortages Nearly of oncologists agreed or strongly agreed that recent drug shortages have disrupted their treatment plans and threatened public safety 76.0% of practices impacted by drug shortages have had to substitute drugs in place of the standard of care Only of SPPs have formal programs to address drug shortages 16 8

9 Cancer Drug Spending & Revenue Payer cancer drug spending Oncology practice drug purchasing & revenue Mandatory use of SPPs 17 Payer Cancer Drug Spending Cancer drug spending growth rates have increased steadily for four straight study periods Drug-only cancer spending (anticipated) The cost of cancer drugs and their administration now account for one-third of MCOs total cancer spending, on average 18 9

10 Payer Cancer Drug Spending (cont.) Employers rated cancer drug costs as the most significant driver of their overall cancer care costs 44.6% of employers have purchased stop-loss coverage to limit their financial exposure to catastrophic medical claims 10.9 % plan to purchase such coverage in Oncology Practice Drug Purchasing & Revenue Cancer drug acquisition costs accounted for an average of 41.1% of oncology practices total expenses in 2011 More than half of community-based OPMs expect this percentage to rise by the end of 2012 On average, practices buy and bill more than half (55.8%) of their cancer drugs, another 27.5% are purchased/supplied by hospitals, and 16.7% come from SPPs One-fifth of practices purchase oral cancer drugs and dispense them directly to patients; another 13.2% plan to do so in

11 Mandatory Use of SPPs SPPs estimated that about two-thirds of their managed care contracts require oncologists to obtain oral oncology agents from them, instead of through a wholesale buy-and-bill channel in 2012 up from about half of contracts in 2011 Average percentage of managed care contracts requiring oncologists to obtain drugs through SPPs (n=15) (n=12) (n=17) 21 Oncology Practice Consolidation, Workload & Staffing Practice consolidation Trend toward hospital-based oncology care Oncologist workload Advanced practice clinicians 22 11

12 Practice Consolidation & Other Reorganization Strategies According to OPMs, 8.0% of oncology practices have joined/ combined with another practice Another 29.0% are considering doing so 17.0% of practices have integrated with or entered into a joint venture with a hospital Another 6.0% have been sold to a hospital Practice reorganization strategies to improve financial performance Affiliate with a group purchasing organization Affiliate with a practice management organization Integrate or enter a joint venture with a hospital Join or combine with another practice Sell practice to a hospital Currently implemented Under consideration in the next 2 to 3 years 23 Oncologist Workload The average percentage of time oncologists spend per week on patient care has declined slightly over the past 5 study periods from 88.0% in 2008 to 83.1% in 2012 The average number of patients seen during a typical day has also declined The majority of surveyed oncologists continue to report increased personal workloads May reflect the intensity of patient services and time spent outside of direct patient care due to administrative and payer-related issues Changes in oncologist personal workload in 2012 Decreased Remained the same Increased 24 12

13 Oncologist Workload (cont.) More patients with cancer is the leading factor influencing oncologists workload changes Factors fueling workload changes Percentage of oncologists More patients with cancer 42.7% More patients requiring a high intensity of services 41.8% More clinical trial participation 37.3% More time spent on reimbursement and payer-related issues 35.5% More patients under survivorship care 30.0% Practice improvements 29.1% Increased market competition 29.1% Reimbursement issues require more time spent with patient 27.3% Practice has added services 25.5% 25 Advanced Practice Clinicians (APCs) 6 in 10 practices reported employing APCs (eg, nurse practitioners and physician assistants) The primary role of APCs in most practices is for patient follow-up visits Oncology practices were most likely to report plans to add/expand the number of APCs on staff in the next 2 to 3 years to improve their financial performance (followed by administrative/ claims staff and oncologists) Percentage of practices in 2012 at which this is a primary role for APCs (n=100) Patient follow-up office visits (outpatient) Patient education Triage patient telephone calls Attend to low-maintenance patients Cancer patient initial visit and workup Clinical trial research coordination Sick and emergency patient visits Act as a scribe during office visits 48.0% 45.0% 44.0% 39.0% 38.0% 64.0% 58.0% 78.0% 26 13

14 End-of-Life & Palliative Care 27 End-of-Life & Palliative Care MCOs 76.2% (n=77) of surveyed MCOs have undertaken initiatives to improve palliative care and end-of-life planning Initiatives Percentage of MCOs Case manager/nurse telephonic support 81.8% Print and Web site educational materials 59.7% Patient education from palliative specialist 27.3% Physician training on how to discuss with patients 24.7% Working with network oncologists to develop guidelines for advanced care planning 22.1% Investigating new reimbursement method for physician services 13.0% Increasing physician payment for palliative care and end-of-life planning 9.1% Incentives for earlier palliative discussions in advanced cancer patients 6.5% Consulting with employers on enhancing inpatient and outpatient hospice coverage 5.2% 28 14

15 End-of-Life & Palliative Care Employers Surveyed employers are most concerned about benefit coverage of cancer screenings, case management, and care navigation However, coverage of end-of-life and palliative care are a greater priority than they were in 2011 Percentage of employers providing benefit coverage related to end-of-life and palliative care Inpatient hospice care 63.4% Outpatient hospice care 62.4% End-of-life counseling 53.5% Access to palliative care 41.6% 29 End-of-Life & Palliative Care Oncologists 86.2% of oncologists reported always or frequently discussing palliative care options and advanced care/end-of-life planning with patients oncologists view this primarily as their responsibility Only 6.3% of oncologists reported that other staff members always discuss palliative care and end-of-life planning with patients Palliative care options and advanced care/end-of-life planning Oncologists 39.0% 47.2% 13.9% Other staff 6.3% 37.1% 56.6% Always discuss Frequently discuss Never/rarely discuss 30 15

16 End-of-Life & Palliative Care SPPs Half of surveyed SPPs offered palliative care and end-of-life planning services in 2012, such as Pain medication management Counseling from board-certified palliative care pharmacists and/or trained SPP staff nurses Referrals to external palliative care specialists 31 Cancer Survivorship Care 32 16

17 Cancer Survivorship Care One-third of oncologists reported that having more patients under survivorship care has fueled changes in their workload OPMs report who is responsible for survivorship care 3.0% Oncology practice coordinates some care with the patient s primary care physician Oncology practice Patient s primary care physician Other 19.0% 32.0% 46.0% One-fourth of practices employ staff as care navigators to coordinate services between the oncology practice and referring and/or primary care physicians 33 Pharmacogenomics 34 17

18 Pharmacogenomics MCOs & SPPs One-fourth of MCOs restricted coverage of cancer drugs to favorable genomic/companion diagnostic test results in 2012 MCOs also reported on their current approach to the management of genomic laboratories/vendors Nothing at this time Early stages of strategy development 30.7% 35.6% Evaluating vendors 15.8% Limiting coverage to preferred vendors or platforms 22.8% One-third of SPPs offered pharmacogenomic services to MCOs in 2012 as part of their oncology services (up from one-fourth in 2011) 35 Pharmacogenomics Oncologists The past 3 study periods have seen an increase in the percentage of oncologists who frequently encounter prior authorization restrictions dependent upon pathology, tumor typing, or genomic marker testing 53.5% of oncologists reported referring more patients to genetic counseling and genomic testing in 2012 vs 2011 Percentage of oncologists frequently encountering prior authorization for testing 18.0% 47.8% of oncologists reported that genetic tests/biomarkers have moderately or significantly improved the cost-effectiveness of their therapy decisions 39.0% reported little to no impact % %

19 Disease Management 37 Disease Management Only 25.7% of MCOs offered a disease management (DM) program for cancer in 2012 DM programs are primarily developed internally by MCOs DM programs are most commonly created for patients with breast, colorectal, prostate, and lung cancer 47 employers offered DM programs as part of their health benefit plans in % of those offer a cancer DM program Such programs most often include Case management Education about cancer screening/prevention Web-based resources 38 19

20 Health Information Technology 39 Health Information Technology The use of health information technology by oncology practices has increased significantly over the last 4 study periods Use of health system information technology (Percentage of respondents) (N=158) (N=150) (N=183) (N=159) EHR = electronic health record; erx = electronic prescribing

21 Health Information Technology (cont.) The use of electronic health records (EHRs) has had mixed results in their impact on the number of patients oncologists are able to see 68 oncologists participate in the Centers for Medicare and Medicaid Services meaningful use EHR Incentive Program 20 met criteria for Stage 1 meaningful use in expect to do so in are unsure of their status Change in the number of patients oncologists are able to see since working with an EHR system 25.0% Increased 49.1% No change 25.9% Decreased 41 Health Information Technology (cont.) 62 OPMs reported on practice changes planned for the next 2 to 3 years to improve financial performance About half anticipate adding/expanding their erx and EHR systems Two-thirds of SPPs reported offering/ planning to offer mobile apps to support patient order status, refill reminders, and patient adherence Percentage of practices (n=62) erx system 53.2% EHR system 50.0% Clinical trial participation 38.7% Financial counseling services to help 35.5% patients secure out-of-pocket funds Referrals to hospitals for treatment 30.6% Oral drug dispensing 29.0% Diagnostic imaging/scans 29.0% Use of specialty pharmacies for drug 25.8% procurement Nutrition services 25.8% Social worker support and services 25.8% 42 21

22 THE 2013 GENENTECH ONCOLOGY TREND REPORT Perspectives From Managed Care, Specialty Pharmacy Providers, Oncologists, Practice Managers, and Employers 2013 Genentech, South San Francisco, CA December