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William T. McGivney

I recently gave a lecture at a well-known graduate school of business, and I was struck by how much it was like a lecture I had given more than 10 years ago, when I was employed by a large national payor. On my last slide, entitled, “Déjà vu all over again: 90s to 00s,” the final line read: “This will be your lecture in 10 years—as we will still be dealing with this, you can borrow my slides.” Indeed, the pressures and tensions currently at work in our nation's health care system are much like those experienced in the early 1990s. Our nation's expenditures on health care could reach $3.6 trillion in 2014 and could then account for 20% of the nation's gross domestic product. Large employers are again expressing substantial concern about the impact of providing health benefits at a high cost to their companies, in an era of global economy in which foreign competitors are not burdened with such costs. Cost concerns within the Medicare and Medicaid programs dominate public policy debate. Nowhere in medicine is the concern about rising expenditures greater than in oncology. Large national private payors tell NCCN that oncology costs represent 12% of a typical payor's overall medical expense budget. Furthermore, these costs for cancer care are growing annually at a rate of 14%, almost double the average growth of a plan's medical costs. One major national insurer has informed me that, in cancer care, the costs of drugs and biologics now exceed all...
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William T. McGivney

In this new JNCCN feature, experts will address issues and programs that will influence the delivery system for cancer care over the next decade. Individual submissions for this new section of JNCCN are most welcome. The return of substantial rates of rise in national health care expenditures, health insurance premiums, and employer contributions is beginning to make the current environment feel a lot like the health care system in the late 1980s and early 1990s. In those days, rising health care costs brought tremendous tension and pressure to bear on both employers and patients in their roles as purchasers of care. These pressures were translocated to health insurers, who were charged to reduce the pressures and, thus, sought to morph into companies that could manage health care. Hence, a managed care industry emerged. Managed care companies did have some modest and transient success in moderating the rate of rise of health care expenditures in the mid to late 1990s. The one successful mechanism used to accomplish this was a focus on aggressively negotiating down the reimbursement for services provided by facilities and by professionals. Managed care companies used the specter of provider exclusion of from “narrow networks” to extract pricing concessions. These pricing concessions from providers were achieved in the early years of the 1990s, when managed care companies rode the crest of power. However, that power began to recede in 1995. The Clinton Health Care Reform debate of 1994 provided one conclusive result, and that was the affirmation of...
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William T. McGivney

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William T. McGivney

In the torrent of writings in health policy and in the sagacity of legislative discussions and health care reform, policy makers vie for inclusion, or even a vague recognition, of their personal view and plan for improving decision-making in the health care system. In these discussions and debates, oncology is always a focus because of the incidence of the diseases and the evolution of the diseases into chronic conditions, and because of the expense of the plethora of innovative biomedical technologies being introduced. If we could only have a system to support clinical and policy decision-making that: was evidence-based; had broad access to the expertise and experience of the best and the brightest researchers and clinicians; was rapid and timely in its evaluation and communication of recommendations about procedures, drugs, and devices; was widely accepted and used by clinicians, patients, and payors; was publicly transparent and participatory; developed comprehensive guidelines with up-to-date recommendations; and provided worldwide access to the guidelines free of charge. How would such a system be designed? Most likely, one should establish tumor-specific panels of experts representing the many disciplines involved in the complex management of these diseases. Formal meetings would be held on an annual basis to evaluate new scientific evidence, decisions of the FDA, and other important events (e.g., the halting of clinical trials for positive or negative reasons). In addition, the panels could be called upon on very short notice to meet by phone to discuss “late-breaking news.” The product of such a scientific,...
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William T. McGivney

The National Comprehensive Cancer Network (NCCN) and our 21 member institutions are dedicated to improving the care available to patients around the world. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and the attendant scientific, evaluative process has become the model for the development and communication of clinical recommendations based on evidence review integrated with expert judgment. The NCCN is pleased to extend our scientific, clinical collaboration to thought leaders in the Middle East and North Africa (MENA). The NCCN–MENA Guidelines Congress held in Abu Dhabi, running from April 23 to 26, 2009, brought together leading clinicians to review the NCCN Guidelines and supporting data and to discuss the applicability of the NCCN Guidelines to patients in this part of our world. As always, the clinical discussion highlighted areas for improvement and clarification in the NCCN Guidelines. As Drs. Azim, Jazieh, and Jahanzeb point out in the accompanying introduction, the work has begun and the initial thinking is published is this “Abu Dhabi Declaration.” Much work remains as experts identify issues for study in trials or through other research methods, issues that relate to possible differences in genetic makeup and its expression, differences in the availability of technology across the 16 countries, and other factors. The NCCN thanks our colleagues in the Middle East and North Africa for their willingness to share their knowledge, expertise, and experience as we work to improve cancer care for patients whom we serve....
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William T. McGivney

On June 5, 2008, The Centers for Medicare and Medicaid Services (CMS) recognized the NCCN Drugs & Biologics Compendium (NCCN Compendium) as an authoritative source of information to be considered regarding coverage determinations about the use of drugs and biologics in cancer care. CMS and its intermediaries and carriers cover specific indications for the use of drugs and biologics if such indications are listed in recognized compendia. The main use of drug compendia is in decisions about indications of drugs beyond the FDA-approved label. At this writing, 2 other compendia are recognized: the American Hospital Formulary Service Compendium (AHFS) and DrugDex. The all important guidance from CMS to carriers and intermediaries on the use of the NCCN Compendium and other compendia likely will be released by the end of July 2008. The NCCN Compendium fully met the criteria established by the Medicare Evidence Development Coverage Advisory Committee (MedCAC) at its March 30, 2006 meeting. Of the 6 compendia evaluated by the MedCAC at that meeting, the NCCN Compendium received the best scores, by far, on important characteristics such as being evidence-based, having public transparency for evaluation of therapies, and including identification and notification of potential conflicts of interest. The recognition by CMS of the NCCN Compendium is the result of a collaborative effort over 3 years between the agency and the NCCN. The NCCN has added many features, such as a multi-faceted search capacity to facilitate use by decision-makers. Importantly, as noted by CMS, NCCN makes the NCCN Compendium available...
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William T. McGivney

The National Comprehensive Cancer Network (NCCN) is pleased to present the first issue of our official journal, JNCCN. One of the interesting tasks of launching a new journal is clarifying what the journal's goals and mission should be. It is important to recognize how that mission fits into and feeds the greater goals of the organization itself. In that context, the goal of JNCCN is easy to understand—to address the issues involved in the appropriate management of the broad spectrum of cancers in a way that leads to improved patient care. To meet that goal, each issue of JNCCN will present a selection of the NCCN Clinical Practice Guidelines in Oncology along with expert reviews and commentary on controversial issues and issues that are important to clinical decision making. JNCCN also discusses the practical application of the guidelines and outcomes data in everyday practice. Finally, the journal will publish original research that serves to advance the understanding of disease processes and their diagnosis and treatment. The decision to create JNCCN was made in response to the tremendous success of the NCCN Clinical Practice Guidelines in Oncology and the continual demand for expanding the discussions of how the guidelines are created and applied. Unlike some guideline efforts across the many fields of medicine, the NCCN guidelines have been widely hailed, used, and accepted as valuable tools because they are delivered in a timely fashion, updated at least annually, and are specific in the recommendations that they include. Furthermore, the NCCN guidelines...