NCCN Guidelines/Database Programs Impact on Clinical and Health Policies
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Review the scientific, evaluative informational products of the NCCN and their impact on clinical decisions, payor policies and QI
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Describe the NCCN Oncology Outcomes Database and its applications in the collection, analysis, reporting and review of concordance and other data
Application of NCCN Guidelines with corresponding G Codes (CMS Demo) in an automated quality evaluation system (The “New, New Thing”)
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© NCCN All rights reserved.
© NCCN All rights reserved.
What is NCCN?
• On behalf of patients, NCCN
seeks to positively influence and improve decisions and policies that impact the access to, availability of, and delivery of appropriate and effective cancer care.
© NCCN All rights reserved.
NCCN Guidelines • Standard for clinical policy in Oncology in United States • Widely available free of charge to Medical, Radiation, and Surgical Oncologists, Oncology Nurses, Pharmacists, Payors, Patients, Consumers, etc. • Over 100 Up to Date Individual Guidelines
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© NCCN All rights reserved.
“NCCN Guidelines Are Useful in Making Patient Care Decisions”
• “Strongly agreed” • “Agreed”
2002 2005 2006 45% 63% 64% 48% 32% 32% 93% 95% 96%
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NCCN / American Cancer Society Treatment Guidelines for Patients
• Bladder, Breast, Colon and Rectal, Lung, Melanoma, NonHodgkin’s Lymphoma, Ovarian, Prostate
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Advanced Cancer and Palliative Care, CancerRelated Fatigue and Anemia, Cancer Pain, Fever and Neutropenia, Nausea and Vomiting
Distress Management Spanish Versions
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NCCN Drugs & Biologics Compendium
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MCAC Scores NCCN Drugs & Biologics Compendium Highest
• MCAC rated NCCN Compendium highest in all review categories, exceeding the scores of previously approved compendia. • Most important category: Adherence to evidence-based criteria and processes in making recommendations
Compendium
– – – – –
– NCCN Compendium
USP-DI AHFS DRUGDEX Facts & Comparisons Clinical Pharmacology
Score (out of 5)
4.5
3.58 3.42 3.42 3.0 2.92
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Payor Use of NCCN Guidelines
Centers for Medicare and Medicaid Services’ Coverage Decision Memo – January 28, 2005
Re: NCCN Colon and Rectal Cancer Guidelines, 2004 “These guidelines recommend consideration of oxaliplatin and irinotecan in Stage IV or salvage therapy in colorectal cancer. Irinotecan is also mentioned as a promising agent in non-small cell lung cancer. Cetuximab is recommended for consideration (with or without irinotecan) as second-line therapy for colon cancer. Bevacizumab (in combination with 5-FU based chemotherapy) is recommended for consideration as first line therapy for colon cancer.”
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Payor Use of NCCN Guidelines
• Re: IMRT for Prostate Cancer
“The Clinical Policy Council at Aetna has reviewed more recent literature and the NCCN’s Guideline update and determined that IMRT for prostate cancer will be considered medically necessary and therefore available for reimbursement.”
• Re: Oxaliplatin for pancreatic cancer
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“NCCN Guidelines Are Helpful with Managed Care”
2002 56%
2005 63%
2006 76%
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ASCO/NCCN Quality Measures
• National Quality Forum (NQF) endorsed the 7 evidence-based quality measures, released in August 2006:
– 3 for breast cancer – 2 for colon cancer – 2 for rectal cancer
• With Commission on Cancer harmonized measures • Available on www.nccn.org
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Goals of the NCCN Oncology Outcomes Database Project
Identify the most efficacious and cost-effective strategies for the management of common oncologic conditions
Monitor & benchmark concordance with guidelines in our member institutions
Describe patterns and outcomes of care
Create a feedback loop to physicians, institutions, guideline development
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Concordance: Patient-Level Feedback to MD
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© NCCN All rights reserved.
Michigan Breast Oncology Quality Initiative (MiBOQI)
• Partnering for Value: University of Michigan Comprehensive Cancer Center, Michigan Blues and NCCN • An inter-institutional collaborative based upon data collection, analysis, reporting, feedback, and action to improve; a coordinated inter- institutional QI program • 12 “community” cancer centers participate
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© NCCN All rights reserved.
CMS Quality Demo
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What is NCCN?
• It is critical that on behalf of
patients, NCCN seek to positively influence and improve decisions and policies that impact the access to, availability of, and delivery of appropriate and effective cancer care.
© NCCN All rights reserved.
© NCCN All rights reserved.