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doi: 10.1097/01.COT.0000290024.18618.d3
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▪Congressional Briefing Highlights 50 Years of Cancer Research Advances

ASCO and the Coalition of Cancer Cooperative Groups together sponsored a Congressional briefing to educate legislators and their staffs about advances in cancer research and treatment achieved through NCI's Cooperative Group Program. Group leaders highlighted specific research achievements and described the role of the federal investment in cancer research.

“A significant portion of the cooperative groups' budgets comes from NCI. Unfortunately, declining funding has caused the Institute to decrease cooperative group funding over the past two years,” said Robert L. Comis, MD, President of the Coalition. “We cannot hope to continue to provide the types of treatment advances that help people with cancer unless we reverse the trend of decreasing NCI funding.”

Since its founding nearly 50 years ago, the Cooperative Group Program has completed some 4,000 clinical trials and treated more than a half million patients, he noted. Trials have provided immediate benefits to a broad population of cancer patients through research that has, for example:

  • Produced long-term survival and cures for the majority of pediatric cancers.
  • Showed that breast-conserving lumpectomy is often a better surgical option than radical mastectomy.
  • Developed paclitaxel as a premier treatment for ovarian and metastatic non-small-cell lung cancers.
  • Established combined chemotherapy and radiation as the most effective treatment for cervical cancer.
  • Defined the role of newer targeted therapies, such as trastuzumab and bevacizumab, in major solid tumors.

“Clinical trials are the vital link between laboratory discoveries and improved patient outcomes,” said another speaker, Joseph S. Bailes, MD, ASCO's Interim Executive Vice President and CEO. “The cooperative groups' research through these trials has brought improved outcomes to millions of people with cancer.”

▪Study: 12 Communities Adopted P4P

Health plans in 12 communities are adopting pay-for-performance (P4P) programs to improve quality and increase hospital and physician efficiency, according to a report from the Center for Studying Health System Change in Washington. The programs tie financial incentive to improved performance.

While increasing numbers of health plans are developing and implementing P4P programs, there is substantial design variation across markets, said Sally Trude, PhD, a health researcher for the Center. The 35 health plans studied by means of site visits last year are in Boston; Cleveland; Greenville, SC; Indianapolis; Lansing, MI; Little Rock; Miami; northern New Jersey; Orange County, CA; Phoenix; Seattle; and Syracuse.

The researchers interviewed plan executives, employer representatives, large medical groups, and hospital systems. Design variations in P4P programs reflect local conditions such as information technology capability, data availability, relative leverage of health plans and providers, willingness of providers to participate, and employer influence. Providers were concerned about the administrative burden of customized programs and the potential for conflicting financial incentives.

The approaches for rewarding providers fell into three categories:

  • Comparing performance with that of their peers.
  • Reaching absolute targets of performance.
  • Demonstrating improvement over previous scores.

“A few plans used a combination of approaches, with the first part of the incentive tied to performance relative to that of peers and the second part tied to improvement,” Dr. Trude and her colleagues noted.

Although providers would prefer health plans to use a single standardized set of measures and methods, this is unlikely given local market differences, the report concluded. A national effort directed at standardization might significantly reduce the extent of customization but also may limit the opportunities for local collaboration with providers.

▪Majority of Medicare Enrollees May Fall into ‘Doughnut Hole’

Nearly seven million seniors and people with disabilities who purchased stand-alone prescription drug coverage are now at risk of falling into a “doughnut hole,” said three long-time Congressional Democrats. This latest setback comes after older people have struggled for months with confusing and inaccurate information about the new Medicare prescription drug program.

According to a report from senior Democrats on the House Ways and Means Committee, led by Ranking Member Rep. Charles Rangel (D-NY), Health Subcommittee Ranking Member Rep. Pete Stark (D-CA), and Social Security Subcommittee Ranking Member Rep. Sander Levin (D-MI), nearly 88% of new drug plan enrollees are at risk of losing coverage for their medications while they continue to pay monthly premiums to their insurers.

The report describes how few individuals have enrolled in plans without doughnut holes, presumably because of the prohibitive cost of such plans. The hole requires seniors trapped inside it to pay for drug insurance and, at the same time, pay the entire cost of the drugs they buy.

Figure. C
Figure. C:
harles Rangel (D-NY): “Folks in the prescription drug plan who haven't hit the doughnut hole yet are in for a rude awakening. [The hole] is so big that millions will fall in and many will never come out. People are going to be angry when they show up to get their medications and are told they don't have coverage, even though they still pay premiums.”

Under the Medicare Part D rules, out-of-pocket prescription expenses between the annual amounts of $2,251 and $5,100 are not covered; and this nearly $3,000 gap has been termed the “doughnut hole.”

“Folks in the prescription drug plan who haven't hit the doughnut hole yet are in for a rude awakening,” Rep. Rangel said. “It is so big that millions will fall in and many will never come out. People are going to be angry when they show up to get their medications and are told they don't have coverage, even though they still pay premiums.”

Key findings of the report include:

  • 88% of prescription drug plan enrollees who purchased non-HMO coverage are enrolled in a plan with a gap—the doughnut hole.
  • 84% of private drug plans have a gap in coverage.
  • In 26 states, some 90% of beneficiaries are enrolled in a plan with a gap.
  • Nationally, only 12% of beneficiaries (fewer than one million people) with new coverage are enrolled in plans that provide any coverage at all in the doughnut hole.
  • Premiums are, on average, more than 250% higher for a plan with full coverage.

Democrats have offered an alternative plan: a proposal to make the Medicare drug benefit simple, affordable, and reliable. Medicare would be required to use its bargaining power to negotiate lower drug prices, and the savings would be used to fill the doughnut hole.

© 2006 Lippincott Williams & Wilkins, Inc.
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