Why Medicare Advantage is lacking on cancer care

City of Hope's Harlan Levine
Harlan Levine, M.D. (City of Hope)

Given the competition in the Medicare Advantage (MA) market, insurers are devising plenty of ways to stand out in the crowd, ranging from grocery benefits to enhanced dental coverage.

But one area that's still lacking in many ways is in cancer coverage. Harlan Levine, M.D., president of health innovation and policy at City of Hope, told Fierce Healthcare in an interview at the HLTH conference last month that it's critical for the industry to "modernize" the definition of parity around cancer.

"You never see someone going into the market and saying to a Medicare Advantage potential customer: We have the best cancer program for you," he said.

Levine said the incentives aren't yet aligned for health plans to really embrace more expansive cancer care networks. Regulators can, however, step in and help, driving changes to keep up with a rapidly evolving space.

What constituted "network adequacy" for cancer care even five years ago doesn't necessarily reflect the reality of how that care is provided today, he said.

"I think there needs to be like really set standards of what we need to modernize our definition of network adequacy," Levine said. "Because the field is changing so quickly."

City of Hope released a study in November 2022 that found patients enrolled in MA were more likely to be treated at hospitals where physicians had less experience in performing complex surgeries. These patients were more likely to die within 30 days of a stomach, pancreas or liver removal, according to the study.

Patients enrolled in traditional Medicare were more likely to be treated at a teaching hospital (23% compared to 8%). Medicare beneficiaries were also more likely than MA members to visit hospitals with a higher medium number of total beds, ICU beds, annual inpatient surgical volume and operating rooms.

In addition, the analysis found that MA members faced a delay of two weeks or more between diagnosis and their first course of therapy. The City of Hope researchers suspect this is related to the greater prior authorization required in MA.

Levine said that for the largest insurers, they are able to weather some adverse selection if they do have some additional costs related to cancer care. The highest-acuity cancer diagnoses are quite rare, and improving outcomes for these patients could drive savings, he said.

"If you don't do the right thing, then the gap between optimal care and typical care is going to widen because of the pace of innovation," Levine said. "And the gap between the haves and the have-nots, the underrepresented and the majority is going to widen also."