Narrow Networks and Disparities in Cancer Care Highlight the Need for Reform
In the ongoing battle against cancer, health coverage alone is proving to be inadequate in ensuring equal access to innovative treatments and reducing disparities in care. The American Society of Clinical Oncology (ASCO) Annual Meeting, which brings together leading experts in the field, serves as a reminder of the sobering truth that many patients, particularly the most vulnerable, are unable to benefit from life-saving advancements.
Over the past three decades, the efforts of dedicated researchers and clinicians have contributed to a 33% reduction in the cancer death rate. However, significant disparities persist based on race/ethnicity, socioeconomic status, insurance type, and geography. These disparities are exemplified by factors such as ZIP codes and proximity to National Cancer Institute-Designated Comprehensive Cancer Centers (NCI-CCC).
While expanding health coverage, such as Medicaid, has shown promise in addressing disparities, it alone is not sufficient. Recent research presented at ASCO revealed that Medicaid expansion was associated with a decrease in mortality and racial disparities for individuals with gastrointestinal cancers. This highlights the importance of improving health coverage as a critical step toward addressing disparities and eradicating cancer.
However, the complexity of the healthcare system and systemic barriers like insurance “narrow networks” exacerbate the challenges in providing equitable cancer care. While narrow networks may be suitable for less complex diseases or primary care, they fall short in the case of cancer. Cancer care has evolved into numerous sub-specialties defined by tumor origin and specific genetic characteristics, necessitating more specialized expertise. By relying on narrow networks in oncology, patients with complex cancers may lack access to the necessary expertise to optimize their outcomes.
Disturbing statistics have emerged, such as the increased risk of mortality within the first month after surgery for cancer patients enrolled in Medicare Advantage (MA), which utilizes narrow networks. For instance, those with MA who underwent stomach or liver removal were 1.5 times more likely to die compared to members with traditional Medicare. Similarly, MA beneficiaries undergoing oncologic surgery on the pancreas faced double the risk of death within the first month.
Furthermore, the restriction of access to clinical trials through narrow network designs hampers progress in discovering new, more effective cancer treatments. Clinical research conducted at specialized cancer centers is essential for launching these breakthrough medications. By limiting access to trials, narrow networks impede the advancement of innovative treatments, disproportionately affecting minority populations who are more likely to have such insurance products.
To bridge the gap between innovation and access, it is imperative to pursue comprehensive reform. At the state level, initiatives like the California Cancer Care Equity Act have expanded optimal cancer care access for Medicaid beneficiaries. Federally, redefining “network adequacy” to include more specialty cancer centers in Medicare Advantage plans could enhance access. Collaboration among stakeholders, including community and academic centers, is crucial to ensuring patients receive care based on need rather than insurance product design. Additionally, leveraging digital innovation through public-private partnerships, such as the CancerX initiative under the White House’s Cancer Moonshot program, can further support better cancer care and research.
It is essential to recognize that health coverage is not synonymous with comprehensive care. The healthcare system must evolve to keep pace with innovations in cancer treatment. Reforming narrow networks is a crucial step toward achieving equitable access to advancements in cancer care. By doing so, we can ensure that all patients, regardless of their background or insurance status, benefit equally from the latest breakthroughs in the fight against cancer.
