Bringing the Payer and Provider Perspectives Together: Dr. Lee Newcomer Shares His Unique Take on Precision Oncology
How precision medicine is moving oncologists away from population-based treatments to more patient-appropriate care
In this episode, we were joined by the prestigious Dr. Lee Newcomer, board-certified oncologist and former senior vice president of oncology and genetics at UnitedHealthcare. Dr. Newcomer made the transition from practicing oncology to functioning as a healthcare CEO after working towards a master's in health administration during a sabbatical from his clinical practice. He realized that by combining his medical background and business role, he could have a huge impact on changing the medical industry in a positive way from the payer perspective.
We were honored to ask Dr. Newcomer some pressing questions about the current costs of cancer care, how diagnostics are currently reimbursed and who should control the development of those diagnostics. His answers gave us a lot to think about.
Listen to the full episode above and download the full PDF transcript here.
Our first question was, “Why is oncology care so expensive?”
Dr. Newcomer explained the complex dynamics behind drug pricing and reimbursement. More specifically, he discussed the role the FDA plays in mandating payment for any FDA-approved cancer therapy, regardless of value. This has led to less competition in the marketplace and sky-rocketing costs, which is why Dr. Newcomer believes those mandates should be loosened, allowing pharmaceuticals to compete.
He went on to discuss another key component of rising healthcare costs—the dominance of two major health systems, which depletes competition and forces health systems and patients to pay exorbitant costs (as much as 156% above retail price).
We also wanted to know why payers will not provide reimbursement for many diagnostics even though they represent about 3% of the healthcare spent but are responsible for 90% of the information needed to make treatment decisions with respect to oncology and targeted therapies.
Dr. Newcomer went into great detail explaining the barriers payers face, including a lack of clinical evidence supporting the use of certain tests and uncertainty over whether those tests will actually change the treatment choice and outcome in a significant way.
Finally, Dr. Newcomer shared his thoughts on who should be controlling the development and reimbursement of these different lab tests and why. His perspective was encouraging, as it points to a future in which payers will work in tandem with molecular labs and oncology practices to ensure patients are getting the right test, that they are clinically validated, and that they are reimbursed fairly—which is exactly our mission at Trapelo Health, and the purpose of our technology platform, Trapelo.
We thank Dr. Newcomer for sharing his expertise as both an oncologist and a payer, and we hope you take the time to listen to this incredibly valuable podcast.
Listen to the full episode above.
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About Our Guest
Lee N. Newcomer, M.D. spends his time creating new approaches to make cancer care more effective and affordable. He utilizes expertise in medical oncology, health plan strategy and operations, health services research, finance and communications to create disruptive approaches for improved care of cancer patients.
The majority of his career was with UnitedHealth Group. He was their Chief Medical Officer from 1991 to 2001 where he built the company’s medical management programs. He focused his later work on the development of performance measures and incentives for the improvement of clinical care. He returned in 2006 to lead an initiative combining clinical, financial and program management experts to focus on cancer care. This team was the first to complete an episode payment program for cancer treatment and it created the first commercial cancer database combining clinical and claims data.
Prior to his work at UnitedHealth Group Dr. Newcomer practiced medical oncology for nine years in Minneapolis and Tulsa, Oklahoma. He served as the Medical Director for Cigna Healthcare, in Kansas City and he was a founding executive of Vivius, a consumer directed venture that allowed consumers to create their own personalized health plans.
He is a former Chairman of Park Nicollet Health Services (HealthPartners), an integrated system of physicians and hospitals based in Minnesota with national recognition for its leadership in quality, safety and cost effectiveness. He is a director at Cellworks and Intervention Insights.
Dr. Newcomer holds a B.A. degree from Nebraska Wesleyan University, a M.D. degree from the University Of Nebraska College Of Medicine and a Masters of Health Administration from the University of Wisconsin at Madison. His clinical training included an internal medicine residency at the University of Nebraska Medical Center and a medical oncology fellowship at the Yale University School of Medicine.