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JNCCN spoke with David C. Hohn, MD, President/Chief Executive Officer of Roswell Park Cancer Institute and NCCN's newly elected Chair of the Board of Directors, about his vision of NCCN's role in today's changing health care environment and its involvement in changing the way cancer treatment of the future is delivered. JNCCN : Dr. Hohn, you've been an academic cancer surgeon as well as a high-profile executive leader at two of this country's premier NCI-designated cancer centers. From your experience, what is the single greatest challenge that NCCN members face today? DCH: When I became a practicing physician in the 1970s, I focused fully on delivering quality cancer care, performing laboratory research, and conducting clinical trials—the hallmarks of the academic medical profession. In those days, I gave little thought to medical economics, reimbursement issues, cost-efficacy, and standards of care, and absolutely no thought to outcomes measurement beyond the relatively simple measures of morbidity, mortality, response rate, time to recurrence or progression, and survival. Although the priorities of medicine have remained essentially the same, the practice of medicine is now heavily influenced by the business of medicine, with the shadowy outlines of concepts like “pay for performance” and “quality or outcome based reimbursement” looming as the sequels to fading images of “managed care.” In other words, medicine, for better or for worse and for the foreseeable future, will be largely driven by the business of medicine and the chilling realities of the rising fraction of gross domestic product allocated to health care...

Recently, I have participated in conversations and worked on projects that revealed widely divergent views of what constitutes a Center of Excellence (COE) for cancer. The practical importance of appropriately defining the critical attributes of a COE was brought home to me through the efforts of several national payers to develop “Center of Excellence Products” for their subscribers. Let me begin by attempting to outline what payers seem to be looking for in these products. Many national payers are now using NCCN resources to inform their decisions regarding medical policy and reimbursement coverage. In my opinion, the guideline efforts of the NCCN represent the most significant example in medical practice of physicians working together to define the standards of care and, hopefully, to rationalize the reimbursement system. The NCCN Clinical Practice Guidelines in Oncology and the NCCN Drugs and Biologics Compendium have garnered unparalleled credibility in the payer community, reinforced by NCCN's Oncology Case Management Program, a day-long symposium for insurance company medical directors and case managers. Based on these efforts and buttressed by their internal data and observations, clearer perceptions of what defines a COE are emerging. As a result, some payers are developing programs to encourage patient referral to such centers, particularly for treatment of complex and rare cancers. Criteria for consideration as a COE for cancer differ among payers. One payer organization is focused on complex surgical procedures, with criteria that include treatment volume for certain complex cancers, having an appropriate mix of board certified specialists, and...