Narrow network insurance plans threaten patient access to treatment choices

Jul 6 2017

Access to high-quality, high-value cancer care is crucial for all patients with cancer. Ideally, following a cancer diagnosis, patients should have the option to choose care from an experienced, multi-disciplinary team of sub-specialists at a comprehensive cancer center that offers the latest cancer treatment and supportive care breakthroughs. Now, this freedom of choice is being threatened by narrow network insurance plans.

A new study from the Perelman School of Medicine at the University of Pennsylvania shows that these lower-cost plans reduce access to certain providers at comprehensive cancer centers, including National Comprehensive Cancer Network^® (NCCN^®) Member Institutions and National Cancer Institute (NCI)-Designated Cancer Centers. The study was published yesterday in the Journal of Clinical Oncology.

"Because cancer care and monitoring is costly, there are strong incentives for insurers to be selective when it comes to oncologists, excluding those who are most likely to attract the most complex and expensive cases," the study's lead author, Laura Yasaitis, PhD, a postdoctoral researcher at Penn said in a press release. Yasaitis and colleagues call for greater access for patients and more transparency from insurers.

"At NCCN our mission is to improve the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. To that end, we applaud Dr. Yasaitis and her colleagues for their call for improved patient access and improved transparency from U.S. payers," said Robert W. Carlson, MD, Chief Executive Officer, NCCN. "NCCN Member Institutions are home to expert physicians, superior treatment options, and quality and safety initiatives that continuously improve the cancer care in the United States and around the world."

Looking at 2014 individual health insurance exchanges, the Penn researchers observed that oncologists affiliated with NCCN Member Institutions and NCI-Designated Cancer Centers were less like to be included in the narrow plan. According to Yasaitis, no matter how the authors looked at the data, there was a clear trend towards exclusion.

"NCCN publishes clinical treatment guidelines that are accessible by any cancer stakeholder so that where a patient lives doesn't determine if a patient lives," said Carlson. "However, the experience, innovation, and expertise found at the NCCN Member Institutions and other comprehensive cancer centers throughout the country should not and cannot be discounted. Stripping patients of a right to choose a comprehensive care approach not only takes away their access to leading innovations and supportive care programs that promote better outcomes, but also stifles the innovation fostered at these leading centers that is changing the face of cancer care as we know it."

In a previously reported 2015 survey of NCI-Designated Cancer Centers conducted with Avalere, NCCN found that 25% of the respondents were excluded by exchange plans offered by the majority of the state's exchange carriers.

Moreover, as noted in a 2016 NCCN Policy Report, studies have shown that patients treated at comprehensive cancer centers indeed realize better outcomes. Wolfson, et al., found that patients diagnosed with common adult-onset cancers (breast, colorectal, lung, hepatic, pancreatic, and gastric) who were not treated at NCI-Designated Comprehensive Cancer Centers had a 20-50% higher risk of mortality compared with patients treated at those centers.

When choosing a health plan, consumers may not be aware of in-network providers, nor the cost of seeing providers out-of-network. However, when diagnosed with cancer, patients want the highest-quality care to give them the best chance of survival. To this end, NCCN believes consumers need greater education when choosing plans as well as increased network adequacy on the part of insurers and policymakers.

World-renowned experts from NCCN Member Institutions diagnose and treat patients with a broad spectrum of cancers and are recognized for dealing with complex, aggressive, or rare cancers. NCCN Member Institutions pioneered the concept of the multidisciplinary team approach to patient care and conduct innovative research that contributes significantly to understanding, diagnosing, and treating cancer. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), developed by volunteer experts from the NCCN Member Institutions are the recognized standard for clinical policy in cancer care and are often the most thorough and most frequently updated clinical practice guidelines available in any area of medicine.