Perspective

Oncology Management Programs for Payers and Physicians:

Evaluating Current Models and Diagnosing Successful
Strategies for Payers and Physicians
By Dawn Holcombe, FACMPE, MBA

Oncology disease is costly—in terms of drugs, hospitalizations, ment decisions and patient monitoring, physicians are unable
end-of-life care, imaging, and diagnostics. Most of these costs to prove the consistency and appropriateness of their care.
occur outside the physician office. As much as three quarters of Adding to this confusion, many external vendors see a busi-
payer costs for cancer care come outside of the physician office ness opportunity in offering solutions to either payers or pro-
and the drugs administered for treatment. Several oncology viders (but primarily payers). Most are for-profit entities
management programs promise to help rein in the rising costs coming from outside the traditional triangle of payer-patient-
of oncology but focus only on the costs incurred in the physi- provider. After 4 to 5 years of experience with some of these
cian services and the administration and costs of drugs in the external oncology management models, both payers and pro-
outpatient setting. viders are learning about the impact they have on the flow of
Payers are looking for help in understanding oncology. care and the sustainability of some model types.
Discussion of what oncology treatment is appropriate, what
delivery models will work best, and how drugs are to be
managed is decidedly on the table for an increasing number Nine Models for Oncology Management
of payers. There is a growing demand for consistency in care There are nine models in play for managing oncology at this
decisions and a reduction in variation (where appropriate) in point, and each has experienced varying degrees of success and
treatment options. potential sustainability. Our review discusses concerns, issues,
Although some payers initially sought reduction in drug cost and considerations for payers or providers exploring the role of
as the primary solution, many early oncology management pro- each model.
grams are now showing cracks and problems. One of the first
initiatives between a large managed-care organization in Mary- Drug Management
land and one external vendor started with physician incentives The focus of the drug management model is on drugs used for
on the basis of higher drug reimbursement rather than on pro- oncology. Tools used are preferred product pricing, formular-
fessional fee negotiations.1 It only took two years for that method- ies, and prior authorizations. This model is offered by compa-
ology to be completely changed, taking many physicians by nies like ICORE Healthcare (owned by Magellan Health
surprise and leading to issues with contracts and negotiations. An Services, Avon, CT), CareCore Oncology (Bluffton, SC), many
oncology management contract suddenly announced between an- specialty pharmacies, and P4 Healthcare (Ellicott City, MD).
other external vendor and a large managed-care entity in the south- Although savings can be generated with this model (predomi-
east was not well received by physicians and is still in active dispute nantly by dropping drug reimbursements and encouraging the
two years later.2 Federal and private drug management programs use of generic or lower-cost drugs), this model does not address
that focused on setting drug prices or copay/coinsurance rates, any aspect of oncology care other than drugs and thus shows
which physicians and patients found to be unaffordable, have re- diminishing returns over time. If decisions focus solely on the
sulted in thousands of patients being referred to more costly hos- price of drugs without direct medical insight into the individual
pital settings under different insurance benefits. patient’s medical situation and disease, there is potential for
In 2011, more payers are looking for truly workable solu- adverse/unintended consequences that affect the patient care or
tions that engage physicians, reduce variation, decrease costs efficacy of the drug combinations. Physicians are not involved
where appropriate (but not at the expense of quality care), and in this model, but they are required to accept the pricing or
create a collaborative business partnership between payers and approval processes, even if they incur a loss on the drugs or the
providers in a region. Physicians across the country are also resources to seek approval. To the extent that drug management
seeking ways to engage payers in dialogue about the manage- model pricing or policies restrict access to a drug deemed ap-
ment of oncology in their regions. Individual practices, regional propriate by the physician, the model moves into the realm of
groups, and state associations are actively coming to the table on medical decision making by other than a physician. One na-
their own. However, the lack of common data platforms, con- tional managed-care organization is using an external drug pric-
sistent technology solutions, and wide variation among physi- ing model that selectively prices a commonly used antiemetic
cians in a smaller practice—let alone those in a larger group drug below physician cost, despite this drug being the only one
encompassing multiple practices—about how, why, and when indicated for highly emetogenic chemotherapy treatments.
to approach payers also create challenges and hurdles that stag- This has reduced access to standard of care treatment for the
nate the process. Without data and formal processes for treat- patients covered by this insurer.

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Disease Management that state successfully convinced the insurer to abandon that
The focus of the disease management model is on managing universal mandate.
symptoms and adverse effects of oncology disease and treatment
from outside the physician office. This model is offered by Retail Infusion Centers
Quality Oncology (owned by Alere, Waltham, MA), ICORE
The retail infusion center model is being piloted in a few areas
Healthcare, and to a limited extent, Innovent (owned by US
of the country. It shifts oncology treatment to freestanding
Oncology, The Woodlands, TX). The challenge for this model
is that return on investment and thus sustainability have been infusion centers, away from physician- or hospital-based cen-
difficult to prove. The model requires physician offices to pro- ters. Although the model has not been in play long, questions
vide clinical treatment plans so that banks of nurses can com- are being raised about its sustainability, about the types of pa-
municate with patients. Patient confusion ensues with multiple tients being accepted at these centers, and about whether the
contacts, and physicians managing the patient care become model adequately allows for the viability of continued care for
concerned about the liability and risks of patients receiving more complex cancer treatments. Physician concerns arise
information from other than their direct care provider with no about their liability for treatments not carried out under their
face-to-face knowledge of the patient and the individuality of direct supervision and implications for efficient and effective
the disease and care. Although disease management is a core continuity of care. Additional concerns are raised about limita-
component of cancer care, it would be more efficient for phy- tions on the type of patients and treatment mix being accepted
sician cancer centers to build formal disease management mod- at these centers. Too many limitations (ie, cherry-picking) can
els that execute similar tracking and monitoring of results to undermine more comprehensive programs that require a bal-
what external vendors promise payers. ance of simple and complex cases to efficiently provide care and
cover resource costs.
Specialty Pharmacy/Pharmacy Benefit
The specialty pharmacy or pharmacy benefit model is designed Radiation Oncology Benefit Management
to shift oncology drugs to specialty pharmacy vendors and send
the payment for oncology drugs through the pharmaceutical This model is offered by commercial radiation oncology benefit
benefit. Payers find greater flexibility to set member benefit managers (like CareCore National, American Imaging Man-
structures related to drugs under the pharmaceutical benefit, agement [Deerfield, IL], National Imaging Associates [owned
but they are also finding unanticipated adverse consequences. by Magellan Health Services], MedSolutions [Franklin, TN],
The health status of patients with cancer changes frequently, and HealthHelp [Houston, TX]) who focus on use manage-
therefore often requiring same-day changes in planned chemo- ment and prior authorization for care provided in medical of-
therapy treatments. This is not a problem when the physician fices. This model has been challenged by the New York
buys drugs and has an inventory from which to take the new Attorney General, which resulted in a partial exemption for
drugs or vial sizes for the changed dose. This does become a oncology from the use management program.4 The American
costly problem for payers if the drug was ordered and shipped Society for Therapeutic Radiology and Oncology has written
from a specialty pharmacy for a specific patient and then cannot formally “Quality of Care Concerns.”5 Payers seek assurances
be used. Once the specialty pharmacy ships the drug, it bills the about evidence-based care and appropriateness of care, but on-
payer, and if the drug cannot be used, it must be discarded cology services may find it more productive to build programs
according to state regulations. Physicians bear the liability for directly with local care providers.
drugs administered to these patients and are often unwilling to
accept the risk of using drugs provided from a source they do
Oncology Benefit Management
not choose. There are some situations in which specialty phar-
macy and physicians have been able to create a working rela- The oncology benefit model is one that includes use manage-
tionship, but that is usually on a one-on-one basis and with ment, prior authorization, approval logarithms, and a new con-
tight working parameters. Specialty pharmacy vendors are most cept called rational physician reimbursement. Vendors of this
often used by physicians whose drug reimbursement is signifi- model include ICORE, P4 Healthcare, and Medco Health So-
cantly below cost, particularly under Medicaid programs. Pay- lutions (Franklin Lakes, NJ). Use of external vendors to effect
ers considering this model will want to consider the financial medical decision making without firsthand knowledge of the
and liability issues and proceed with caution and in close con- patient has been considered by a few payers, but none of those
nection to the physician cancer centers in the area. Most often, contracts have gone smoothly, and significant physician con-
general mandates to conversion to specialty pharmacy have not cern has been raised. Payer interest in this model has slowed
gone smoothly, and many are abandoned within a short time. measurably in the last two years, and more collaborative alter-
The largest private insurer in a major northeastern state recently natives are being reviewed. The first contract of this type was
mandated that all injectable and oral drugs be obtained from a announced in a large southeastern state in mid 2009, and the
specialty pharmacy, even for use in a physician’s office.3 For negative reaction from the oncology community was so strong
several reasons—including additional cost of drug waste and that it is still being contested 2 years later and will ultimately not
concerns over the impact on patient care—the oncologists in prove to be sustainable.2

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Collaborative Payer/Physician Programs vendor that is starting to offer a front-end solution to payers as
Collaborative payer/physician programs are emerging rapidly an authorization tool for use by physicians is eviti (owned by
(primarily as a solution to the stops and starts of other failed ITA Partners, Philadelphia, PA).
models) and eliciting great interest from payers and physicians Physicians are usually actively engaged in a front-end com-
alike. This model does require a joint approach to data and pliance pathway program and, through the decision-making
development of programs. It is a progressive relationship (step iterations, usually arrive at recommended treatments for the
collaboration like step therapy) and, when done most effec- state and stage of disease of individual patients. Approximately
tively, starts with a joint data review and expands into a few 20% of the time, that treatment is not selected, but the physi-
pilot programs. Eventually, tools like guidelines or pathways or cian documents the reasons why for a continuous information
end-of-life management programs will be implemented, but loop. Pathways programs address more than 90% of cancers,
those are usually not the first point of discussion—for good but they may be difficult to implement at the first round of
reason. Both payers and physicians have vastly different per- discussions with payers and providers for a variety of technical,
spectives on goals, methodology, and issues. It takes time to cultural, and procedural reasons. Pathways are a hot topic for
build trust and understand each other’s perspectives as well as to both payers and providers, but they can cause delays if intro-
identify and prioritize cancer management for the market. Ex- duced too quickly in the relationship. There will be a fine bal-
isting successful models have grown over time in selected mar- ance between the engagement of a clinical community and the
kets and have been the product of ongoing joint effort between full transparency of data and information exchange and the
one or two practices and a willing key payer. The collaboration application of web portals for clinical decision making. If that
between Premara Blue Cross and Cancer Care Northwest in balance is not achieved, some front-end decision-making pro-
Oregon has been in process for about 5 years and is yielding grams will likely fail if they are perceived as tools for limiting
notable care and cost results. care choices instead of as tools to support physician medical
Seizing on one vendor tool and jumping into a relationship decision making.
on the basis of that tool could lead to a less than ideal launch and
to frustration on both sides; it is almost like fitting a square peg Back-End Compliance Programs (Preferred
into a round hole. Flexibility and preparation are key to suc- Treatment Menus)
cessful collaboration. Even as health care delivery evolves and
models like accountable care organizations are developed, the A back-end compliance program is also a tool rather than a
crux of effective, efficient care will be grounded in the precepts model for oncology management. It is called back-end because
of good medical decision making and strong data platforms. it relies on data collection after treatment or on treatment doc-
External management models will not yield the results that umentation (with some added manual data) to prove compliance
collaborative models can. Collaborative models and relation- retroactively against a menu of several preferred treatments. This
ships are ultimately sustainable and the primary models for menu is unique to each disease but not tailored to an individual
successful payer/physician relationships. patient’s state and stage of disease. Practices agree to allow a
cookie into their practice system to retrieve all claims data for
Front-End Compliance Programs (Pathways) reporting purposes. P4 Healthcare has executed some contracts
Front-end compliance programs or pathways are often consid- for this model, predominantly with payers as a compliance tool.
ered a model, but they are actually tools to be used in a collab- Contracts executed with payers and then announced to physi-
orative payer/physician program. The goal of a front-end cians have traditionally not gone smoothly. Most states in
compliance program is to support evidence-based medical de- which these back-end contracts have been introduced have not
cision making by physicians at the point of the decision for been fully executed as a result of conflicts that have arisen.
cancer treatment. Payers encourage these programs because of Challenges with existing back-end compliance programs center
their documented ability to reduce treatment variation, follow around limited data sets, management of data, and concerns
evidence-based guidelines, and ultimately decrease costs over about the sustainability of the preferred menu model for payers
the full continuum of care rather than just for drugs. Physicians and physicians. Major drug distributors International Oncol-
seek these programs because they can prove that they use evi- ogy Supply and McKesson have developed software programs
dence-based care and, hopefully, streamline the payer accep- to track treatment regimens and provide reporting in a back-
tance of those choices. Two programs that are physician-driven end manner as well, but to date, they have no known contracts
are Innovent Oncology and Via Oncology (owned by the Uni- supporting payer/physician relationships.
versity of Pittsburg Medical Center, Pittsburgh, PA). Another
emerging program is from a partnership between the National
Comprehensive Cancer Network (NCCN) and Proventys Seven Essential Elements for Successful
(Newton, MA). This is the only program that uses technology Oncology Management
to document and support physician decision making directly When evaluating potential models that may become the cor-
from the nationally recognized standards of care—the NCCN nerstone of an oncology management model, there are at least
guidelines. Other programs use reinventions of those guidelines seven elements to consider as indicators for sustainability and
as a result of the proprietary rights of NCCN. Another external success.

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 Will it lead to the right care in the right setting at the right Under health care reform, payers will be held accountable
time? If not, it only addresses a limited scope of oncology and is for monies spent proportionately on administrative costs
likely to be unsustainable and self-limiting. rather than on medical care expenditures. Collaborative pro-
Does it contribute to a decrease in variation yet still allow for grams and models that support and directly interact with
the complexity of oncology and physician medical decision physicians rather than external vendors will also support
making? If not, it will be difficult to engage the physicians and payers on medical costs.
will become unsustainable and self-limiting. Ultimately, success for both physician/payer relationships
Does it fully engage physicians? If physicians are not in- will hinge on trust, data, mutually acceptable evidence-based
volved in the development and decision making around the decision making, accountability, and support for the physician-
program, it greatly increases the likelihood that the program based community care model. Successful management of on-
will entail onerous requirements or interfere with efficient and cology lies in the medical decision making and not in the drugs;
effective patient care and thus become untenable. External ven-
it will address the costs along the full continuum of care. Careful
dors that provide models that will be imposed on physicians
selection of partners and models will support rather than hinder
rather than engage physicians collaboratively will quickly prove
successful payer/physician oncology strategies, although the
the model unsustainable. Physicians are the link between the
journey will entail a truly broad and strategic approach rather
patient and the care provided as well as the primary drivers of
than reliance on one model or tool.
efficient, quality care. The engagement of other care profession-
als (like nurses and pharmacists) and patients and their role in
the care process are also significant factors, but this discussion Accepted for publication on March 28, 2011.
focuses on the interactions between the care provider, who
makes the medical decisions, and the payer. Author’s Disclosures of Potential Conflicts of Interest
Although all authors completed the disclosure declaration, the following
Does it affect the total oncology spectrum? If it does not and author(s) indicated a financial or other interest that is relevant to the
focuses on only one aspect of oncology care, such as drugs, it subject matter under consideration in this article. Certain relationships
may lead to penny-wise and pound-foolish results and not be marked with a “U” are those for which no compensation was received;
successful in the long run. those relationships marked with a “C” were compensated. For a de-
What data are obtained, how, and by whom? Reporting is tailed description of the disclosure categories, or for more information
about ASCO’s conflict of interest policy, please refer to the Author
the only way to create information, and information be- Disclosure Declaration and the Disclosures of Potential Conflicts of
comes proof of what was done or not done. Information will Interest section in Information for Contributors.
only be effective if it is fully shared between the payer and the
Employment or Leadership Position: None Consultant or Advi-
provider, so models or solutions that track one-sided data sory Role: Dawn Holcombe, ION Oncology (U), Via Oncology (C),
will ultimately fail. Proventys (C) Stock Ownership: None Honoraria: Dawn Holcombe,
Does the program support a journey or a single step? On- Via Oncology, ION Oncology Research Funding: None Expert Tes-
cology is complex and rapidly changing. Building trust and timony: None Other Remuneration: None
collaborative relationships paves the way for a series of evolving
projects. In the early years of these relationships, programs have Dawn Holcombe, FACMPE, MBA, is President, DGH Consulting, South
been announced with great fanfare and have slowly disappeared Windsor, CT.
quietly, primarily because they were built around one solution
and did not build the groundwork for an ongoing collaborative
relationship. DOI: 10.1200/JOP.2011.000305

References
1. P4 Healthcare Oncology: P4 Healthcare and CareFirst BlueCross BlueShield 4. Office of the New York Attorney General: Attorney General Cuomo announces
launch oncology pathways program. http://www.p4healthcare.com/Oncology/ agreement with Excellus and Carecore to ensure cancer patients get timely critical
Article.aspx?ContentId⫽316013 care services. http://www.ag.ny.gov/media_center/2008/jun/june24b_08.html
2. Blue Cross Blue Shield Association: Provider administered drug program.
http://providermanual.bcbsfl.com/brs/padp/Pages/default.aspx 5. American Society for Therapeutic Radiology and Oncology: Quality of care
3. insurancenewsnet.com: Blue Cross, Berkshire Hematology Oncology spar. concerns regarding the activities of radiation oncology benefit management
The Berkshire Eagle, January 8, 2010. http://www.insurancenewsnet.com/ companies (ROBM). http://www.astro.org/PublicPolicy/WhitePapersAndOther
article.aspx?id⫽151537&type⫽newswires Documents/documents/ROBM.pdf

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 Volume 7, Issue 3S Supplement to May 2011

JOURNAL OF The Authoritative Resource

for Oncology Practice

ONCOLOGY
PRACTICE

C O N TE NTS

FOREWORD
Developing Dialogue in Health Care
John V. Cox and A. Mark Fendrick. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17s

ORIGINAL CONTRIBUTIONS
E Genomic Testing and Therapies for Breast Cancer in Clinical Practice
• Despite almost universal testing for HER2, many women with HER2-positive cancer may not receive
trastuzumab. Fewer women received newer gene expression profile testing.
Jennifer S. Haas, Kathryn A. Phillips, Su-Ying Liang, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e1s
Health Technology Assessment and Private Payers’ Coverage of Personalized Medicine
• A study of major US private payers showed an important role and considerable shortcomings of external
health technology assessment in coverage decisions on personalized medicine.
Julia R. Trosman, Stephanie L. Van Bebber, and Kathryn A. Phillips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18s
Characterizing Medical Care by Disease Phase in Metastatic Colorectal Cancer
• This study characterized patterns and costs of medical care by disease phase in patients with newly
diagnosed mCRC using a large US national commercially insured claims database.
Xue Song, Zhongyun Zhao, Beth Barber, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25s
Advancing Performance Measurement in Oncology: Quality Oncology Practice Initiative
Participation and Quality Outcomes
• American Society of Clinical Oncology Quality Oncology Practice Initiative has grown to include 973
practices as of 2010. Practices demonstrated rates of end-of-life care and other measures of quality.
Francis X. Campion, Leanne R. Larson, Pamela J. Kadlubek, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31s
E Effect of the Pay-for-Performance Program for Breast Cancer Care in Taiwan
• The pay-for-performance program for breast cancer care had a positive impact on breast cancer outcome in
Taiwan. Enrollees received higher-quality care and had better outcomes.
Raymond N.C. Kuo, Kuo-Piao Chung, and Mei-Shu Lai . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e8s
continued on following page

Journal of Oncology Practice (ISSN 1554-7477) is published bimonthly (January, March, May, July, September, November) by the American Society of Clinical Oncology,
2318 Mill Road, Suite 800, Alexandria, VA 22314. Periodicals postage is paid at Alexandria, VA, and at additional mailing offices. Publication Mail Agreement Number
273. Editorial correspondence should be addressed to John V. Cox, DO, Journal of Oncology Practice, 2318 Mill Road, Suite 800, Alexandria, VA 22314; phone:
703-797-1900; fax: 703-684-8720; e-mail: [email protected].
POSTMASTER: ASCO members should send changes of address to American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA 22314.
Nonmembers should send changes of address to Journal of Oncology Practice, Customer Service, 2318 Mill Road, Suite 800, Alexandria, VA 22314. Annual subscription rates
(effective through August 31, 2011): United States and possessions: ASCO active-allied, $50; ASCO international corresponding, $50; ASCO associate, $50; nonmember
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current and back, exist in limited quantities, and are offered for sale subject to availability.
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 Volume 7, Issue 3S Supplement to May 2011
.....................................................................................................................................................................................

Do Economic Evaluations of Targeted Therapy Provide Support for Decision Makers?

• Economic evaluations of adjuvant trastuzumab were reviewed. Three primary shortcomings were identified
including incorporation of local data and estimation and representation (visual) of decision uncertainty.
Ilia L. Ferussi, Natasha B. Leighl, Nathalie A. Kulin, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36s
Patient and Plan Characteristics Affecting Abandonment of Oral Oncolytic Prescriptions
• Ten percent of patients abandon newly initiated oral oncolytics at the pharmacy. Patients facing higher cost
sharing or increased concurrent prescription activity have a higher abandonment rate.
Sonya Blesser Streeter, Lee Schwartzberg, Nadia Husain, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46s
Pathways, Outcomes, and Costs in Colon Cancer: Retrospective Evaluations in Two
Distinct Databases
• Retrospective evaluations of electronic health records and claims databases assess clinical outcomes
and costs associated with evidence-based pathways in colon cancer.
J. Russell Hoverman, Thomas H. Cartwright, Debra A. Patt, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52s
E Racial Variation in the Cost-Effectiveness of Chemotherapy for Prostate Cancer
• The likelihood of chemotherapy being cost-effective for patients with metastatic prostate cancer differs
across racial subgroups. This uncertainty presents challenges for managed-care decision makers.
Michael Grabner, Eberechukwu Onukwugha, Rahul Jain, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e16s
E Impact of Clinical Oral Chemotherapy Program on Wastage and Hospitalizations
• An oral chemotherapy cycle management program offers clinical support, reduces medication wastage, and
provides management of adverse effects to realize cost savings for payers and patients.
Nikhil Khandelwal, Ian Duncan, Tamim Ahmed, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e25s
E Impact of New Drugs and Biologics on Colorectal Cancer Treatment and Costs
• We measured the financial consequences of new colorectal cancer treatment regimens. New regimens have
increased cost directly through price and indirectly through nonstandard and second-line regimen use.
Pinar Karaca-Mandic, Jeffrey S. McCullough, Mustaqeem A. Siddiqui, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e30s
E US Insurance Program’s Experience With a Multigene Assay for Early-Stage Breast Cancer
• This study presents Humana’s experience with a multigene breast cancer assay and provides an analysis of
the clinical utility and economics of this technology.
John Hornberger, Rebecca Chien, Katie Krebs, et al . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e38s

PERSPECTIVES
E Oncology Management Programs for Payers and Physicians: Evaluating Current Models
and Diagnosing Successful Strategies for Payers and Physicians
Dawn Holcombe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e46s
E Journey Forward: The New Face of Cancer Survivorship Care
Jennifer Hausman, Patricia A. Ganz, Thomas P. Sellers, et al. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e50s
Trying Something New: Episode Payments for Cancer Therapy
Lee N. Newcomer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60s
Are We Winning the War on Cancer?
Ted Okon and Lee Schwartzberg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62s

This supplement was developed through collaboration between the American Society of Clinical Oncology, Inc., and Managed Care & Healthcare Communications, LLC,
and has been published jointly by invitation and consent in Journal of Oncology Practice and the American Journal of Managed Care. Copyright © 2011 American Society of
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