The Role of the Private Sector in Health Care Reform
Authors: Elizabeth Danielson
Journal: Journal of the National Comprehensive Cancer Network (2012)

In his commentary in the January 2012 issue of JNCCN, David Hohn, MD, 1 laid out many of the opportunities, concerns, and uncertainties related to health care reform and the potential impact on cancer centers, physicians, and patients.By the time you read this, we will probably know if the Supreme Court upheld the Patient Protection and Affordable Care Act (PPACA) or ruled the entire Act or portions of it to be unconstitutional.Regardless of the Supreme Court's decision, however, the landscape for health insurance and medical care has already been unalterably changed and will continue to evolve.Especially if PPACA is overturned, the private sector, and self-funded employers in particular, will play an important role in the further evolution of the health care system.Self-funded employers choose to assume financial responsibility and risk of paying their beneficiaries' medical and pharmacy plan expenses, rather than transferring that responsibility to a managed care organization or insurance company.Self-funded plans are not subject to state insurance mandates related to benefits and coverage but are instead governed by Federal ERISA (Employee Retirement Income Security Act 2 ) legislation.Self-funding gives employers increased flexibility in designing their employee benefits, and they have used it.The private sector serves as an innovation laboratory as employers, managed care organizations, and others address the challenges of cost, quality, and productivity, and design benefits to meet their needs and the needs of beneficiaries.This includes, of course, medical and pharmacy coverage, but also disability and employee assistance programs and programs to prevent and manage illnesses, and promote "wellness."NCCN only recently became involved in public policy issues when, in 2008, NCCN sought and achieved recognition of the NCCN Drugs & Biologics Compendium (NCCN Compendium) as the basis for coverage decisions for Medicare beneficiaries.Since then, NCCN has taken a greater role in influencing public policy on issues that affect cancer care.NCCN is taking a leading role in developing policy in the private sector as well, by collaborating with managed care organizations, large employers, and employer coalitions.NCCN's collaboration with the National Business Group on Health to develop An Employer's Guide to Cancer Treatment & Prevention (the Guide) is an example of this, and is the most extensive venture to date.It is also arguably the most likely to have a farreaching impact.The Guide provides practical, ready-to-implement recommendations and tools to help employers design and implement cancer-related employee benefits.It addresses cancer-related issues across the benefit continuum, including wellness, prevention, and screening; medical and pharmacy benefit plans; disability and employee assistance plans; family medical leave and caregiver needs; survivorship; and end-oflife care.Recommendations in the Guide are supported by evidence and insights from a wide range of sources, including the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and NCCN Compendium.Through adopting benefit recommendations in the Guide, employers can be more confident that their cancerrelated benefit dollars are being invested wisely and will meet the needs of beneficiaries.Some of the recommendations likely to have an important and far-reaching impact relate to: Medical plan coverage for: