CPC & CBEx 2023: Critical Trends in the Oncology Landscape

To open Friday’s schedule of sessions at the Clinical Pathways Congress & Cancer Care Business Exchange, Lee Blansett, MBA, Executive Vice President for HMP Market Access Insights, discussed critical trends in today’s oncology landscape. 

Blansett opened the morning’s session by emphasizing that all the major market players in the oncology space are consolidating. With so much treatment variation in the modern oncology space, big aggregators need a way to stay abreast of new developments in care. 

Economic concerns for providers are driving the trend of consolidation into larger entities as they seek economic scale and bargaining power against suppliers and payers. Roughly 60% (8500) of oncologists currently work within an integrated data network (IDN) setting. The number of oncologists working within aggregators sits at 2100. That leaves just 2800 practicing oncologists working in a traditional independent practice/office setting. Most of these oncologists do not see themselves practicing independently in the future. As the trend toward consolidation continues, less formal partnerships called “affiliations” are also taking place. 

To serve their own and other payers’ members, the largest vertical payers expand into health care services, including pharmacy benefit networks (PBMs). Examples of this include Humana partnering with Enclara and United Healthcare partnering with Optum Rx. 

Blansett went on to state that the rapid rate of clinical innovation and new approvals challenges providers to keep current, which makes guidelines, clinical pathways, and point of care information of critical importance. Significant progress has been made in getting better care to patients, with new and novel drug therapies serving as the biggest contributor to this. The average, run-of-the-mill oncologist is not prepared to handle all the rapidly changing treatments—that’s where pathways come in. They enable oncologists to be confident they are delivering the most updated and effective care for their patients. 

United Healthcare’s share of cancer has grown substantially due to the increase in Medicare Advantage concentration. Assuming current growth rates continue, a majority of senior cancer patients will be covered by Medicare Advantage plans by the end of 2023. 

Oncology has become a high priority for commercial payers; however, the rising senior risk will lead to tighter management as spend rises rapidly among this demographic. Illustrative of this, cancer spend is expected to grow to 120 billion by 2027. Within Medicare, oncology is the single highest cost medical group, and Medicare medical pharmacy spend is nearly double commercial spend.