Dawn Holcombe, MBA, FACMPE, ACHE
Editor-in-Chief
President, DGH Consulting, South Windsor, CT
President, DGH Consulting, South Windsor, CT
Dawn Holcombe is President of DGH Consulting, which provides consulting and speaking services to practices, pharma, and payers in strategy development, MD/payer negotiations and relationships, and oncology management and pathways.
Authored Items
October 2023, Vol 13, No 10
Every day, providers and patients struggle with health plan, pharmacy benefit manager, specialty pharmacy, and other intermediary coverage and reimbursement policies that adversely affect individuals with cancer. These challenges may include coverage delays, step edits, prior authorizations, nonmedical switching, high out-of-pocket costs, and/or the intrusion of intermediaries into care or the drug chain, leaving patients confused, frustrated, and reeling from financial, physical, and emotional distress. Read More ›
August 2023, Vol 13, No 8
Where do we really stand when it comes to artificial intelligence (AI)? What is the value? Who is using it? What are the risks and drawbacks? This technology has been discussed as a solution to complicated medical management as long ago as the 1970s, in the early days of developing clinical decision support systems. Read More ›
June 2023, Vol 13, No 6
In the December 2022 and February 2023 issues of Oncology Practice Management, I identified external vendors (called specialty drug carve-out or alternate funding programs [AFPs]) that are charging self-insured employers a fee to find “specialty funding” or other resources so that employers and employees can pay sharply reduced prices, or nothing at all, for expensive drugs. However, these specialty carve-out vendors do not disclose the sources for this alternative funding or the drugs themselves, hiding the true impact of this practice on patient care and charity. Read More ›
April 2023, Vol 13, No 4
Big business has been investing billions of dollars per year into healthcare, and, if successful, it may make private practices and community hospitals anachronistic. Read More ›
February 2023, Vol 13, No 2
Practices and patients are now coming forward to explain how these programs have put individuals, patient assistance programs (PAPs), foundations, and other patient support systems at risk. Read More ›
December 2022, Vol 12, No 12
Self-insured employers, perhaps even yours, are being presented with programs called “specialty carve-outs” as an opportunity for saving significant money on the drug portion of their employee benefits. Read More ›
October 2022, Vol 12, No 10
Decades ago, I remember when biosimilars were a light on the horizon. Visions of sharply discounted alternatives to reference brands that could swoop in and help patients receive the care they needed at prices that were at least 50% below current market rates. Read More ›
August 2022, Vol 12, No 8
We now know what will follow the Oncology Care Model (OCM). On June 27, 2022, the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center announced the voluntary Enhancing Oncology Model (EOM). Read More ›
August 2022, Vol 12, No 8
The new proposed Centers for Medicare & Medicaid Services (CMS) Enhancing Oncology Model sets forth the expectation that medical practices will actively engage with patients as they go about their daily lives between office visits, tracking symptoms, and monitoring adverse events that can lead to costly medical interventions. Read More ›
June 2022, Vol 12, No 6
Have we lost the concept of common sense in our aggressive pursuit of “value” in healthcare? Read More ›
April 2022, Vol 12, No 4
The United States Pharmacopeia (USP) Convention was first held in 1820 when 11 physicians gathered to set standards to ensure that a prescribed medicine would be the same, regardless of where it was created or where a patient lived. Read More ›
April 2022, Vol 12, No 4
On June 1, 2008, the United States Pharmacopeia (USP) General Chapter 797 Pharmaceutical Compounding – Sterile Compounding (USP <797>) was made official. Read More ›
February 2022, Vol 12, No 2
Anemia can have a significant negative impact on quality of life and overall prognosis in patients with cancer. Read More ›
December 2021, Vol 11, No 12
Pharmacy benefit managers (PBMs) have developed a new approach to marketing themselves as stewards of the self-funded employers’ healthcare benefit, and it is having direct negative consequences for patients. Under the alternate funding program, new or costly therapies used to treat serious and chronic conditions, including cancer, are being singled out. Read More ›
October 2021, Vol 11, No 10
On August 31, 2021, proposed revisions to the United States Pharmacopeia (USP) General Chapter 797 Pharmaceutical Compounding – Sterile Compounding (USP) were published. For several years, different versions of USP have fostered concern and confusion about whether these pharmacy standards apply to (and will impact) the drug preparation and handling that is an integral part of oncology medical practices, as well as other specialties. Read More ›
August 2021, Vol 11, No 8
On July 1, 2021, a new Anthem policy on drug dose reduction for dozens of oncology treatments became effective in 14 states (CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, and WI). Physicians and patients across the country are questioning whether this has become a prime example of a private payer coverage policy that is driven more by fiscal concerns than evidence-based medicine, interfering with patient access to standard-of-care treatments. Read More ›
June 2021, Vol 11, No 6
Pharmacy benefit managers (PBMs) have become a fixture in the drug supply chain. They serve as administrators of prescription drug benefits for those who pay for care, including commercial health plans, self-insured employer plans, Medicare Part D plans, and state government employee plans. According to the Pharmaceutical Care Management Association (PCMA), PBMs administer prescription drug plans for more than 266 million Americans. Read More ›
June 2021, Vol 11, No 6
Although the role of biosimilars in the treatment of patients with cancer has been under review by payers and providers for several years, there remains conflicting application regarding policy and strategy. There is a growing need for discussions on biosimilars in the context of the current landscape, utilization and evidence, impact on costs of care, quality and payment reform, and potential policy and strategy solutions. Read More ›
2021 Oncology Drug Coding and Updates
We are pleased to present this 2021 Oncology Drug Coding and Updates special feature, designed to provide you with helpful information on the topic of oncology drug coding and important details on some of the drugs now available to treat patients with cancer. The COVID-19 pandemic led to many changes in patient care and treatment choices for oncology practices. Flexibility and innovation regarding both oral and infused/injected drugs became key to ensuring patient access to necessary treatments. Read More ›
April 2021, Vol 11, No 4
Rumors about the entry of Amazon into the healthcare arena have been circulating for years. Now, it has become a reality in all 50 states. Although there is no guarantee that this venture will be successful, it is likely to become a seismic event for all healthcare providers and patients. Therefore, it is important to acknowledge and address its potential impact sooner rather than later. Read More ›
February 2021, Vol 11, No 2
Last year was an adventure. We learned a lot, and we changed even more. Many of us woke up on January 1, 2021, wondering what the new year would bring. We are already getting some answers. Activities and initiatives that slowed down during the learning curve of the COVID-19 pandemic are beginning to rev up again. The ushering in of the new administration has opened doors to staffing and policy changes, with new directives being sent out at an unprecedented rate. Read More ›
December 2020, Vol 10, No 12
No one can say that 2020 has been an ordinary year, although for most of us, it started out in a fairly normal manner. For me, it meant celebrating the New Year, writing, and enjoying some occasional snow. My speaking engagements and travel began ramping up in January, February, and early March, which allowed me to meet with colleagues and clients at practices, hospitals, and conferences. Then, the COVID-19 pandemic hit, and the bottom dropped out of all our worlds. Read More ›
October 2020, Vol 10, No 10
In addition to the ongoing COVID-19 pandemic, the oncology community has been buffeted by a cacophony of headlines and concerns regarding the cost of care, value-based performance contracts, staffing shortages, revenue cycles, clinical pathways, and competition. Entire industries, such as medical benefit managers, have sprung up to oversee providers and ensure that they are delivering only medically necessary care. Although we know that all of the things we do on a daily basis are aimed at improving the lives of patients, this extraneous noise can be distracting and disconcerting. Read More ›
October 2020, Vol 10, No 10
Each individual can choose the way he or she reacts to the topic of death; it is a unique journey for each of us. In general, our experiences can be divided into 2 types: coming to terms with our own death and experiencing the death of others. In his newly released book, Between Life and Death: From Despair to Hope, Kashyap Patel, MD, explores both of these perspectives as he recounts the story of a terminally ill patient named Harry, who has decided to accept death with the fullest spirit and without hesitation, and who tries to prepare for his own death by learning about other patients’ experiences. Read More ›
September 2020, Vol 10, No 9
Medical practices entered a strange new world of patient safety requirements during the COVID-19 pandemic, and life will never again be the same. Regardless of size or specialty, all medical practices face significant challenges to protect their patients, community, and staff by reducing the risk of spreading the COVID-19 virus, while simultaneously maintaining their financial viability. Read More ›
August 2020, Vol 10, No 8
In the best of times, managing an oncology practice is an adventure. Every day the doors to the practice open, and the physicians and staff greet, support, and empower the patients who come in for guidance, diagnosis, and treatment. Read More ›
2020 Oncology Drug Coding and Updates
The COVID-19 pandemic has transformed healthcare delivery around the world, including the treatment of patients with cancer. As providers and administrators strive to create and implement new procedures to protect their staff and patients from the virus, it is equally important that they continue established protocols that are critical to the effective management of their practices during these unprecedented times. With this goal in mind, we are pleased to present this 2020 Oncology Drug Coding and Updates special feature, designed to provide you with important information on the topic of oncology drug coding and details on some of the newest drugs available to treat patients with cancer. Read More ›
June 2020, Vol 10, No 6
Over the past several decades, we have seen the delivery of chemotherapy shift from the hospital inpatient setting to the hospital outpatient setting to the specialized community practice setting. Now, amid the many seismic changes that have been occurring as a result of the COVID-19 pandemic, a battle has emerged over the question of whether a patient’s home should be a site of care for the infusion of certain chemotherapy drugs. Read More ›
April 2020, Vol 10, No 4
Every cloud has a silver lining. The chaos and uncertainty that the novel coronavirus disease (COVID-19) brought to the US healthcare system this spring has had a cataclysmic effect on the mainstream adoption of telemedicine and virtual health visits that will probably never be undone. These advances in technology will benefit medical practices and their patients in much needed ways, such as lowering costs, improving patient access, increasing the timeliness of care, and reducing the risk for unnecessary exposure to various elements for patients and staff alike.
Read More ›February 2020, Vol 10, No 2
As we enter a new decade, we are seeing a widening gap between those who provide care and those who pay for care. This growing divergence is evidenced, in part, by the different sources being used for clinical pathways and authorized coverage for payment. Initially, payers tend to consider national guidelines, such as the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, as a starting point for acceptable treatment choices made by physicians, but then refer to internal policies or external vendors to narrow the parameters required for clinical and payment coverage. Read More ›
December 2019, Vol 9, No 12
Still waters run deep. While cancer centers and practices continue to navigate the highly visible challenges of operations, reimbursement, and competition, as well as Medicare and private payer relationships, other potential hazards may be lurking just out of sight. This article discusses 3 areas where activity in your local market could suddenly surface and completely change the environment in which you provide care. Read More ›
October 2019, Vol 9, No 10
Although our top priority is to provide high-quality care, we often encounter barriers and hurdles that can affect where, when, and how we interact with our patients and staff. Given the increased focus on the acquisition, handling, preparation, and administration of drugs in medical practices—especially oncology practices—we are now being challenged with existing and emerging restrictions and expectations, which are continually in a state of transition. In this article, I want to share 3 important tips that will help you be more prepared and protected this fall. Read More ›
August 2019, Vol 9, No 8
Medical practices and hospital centers across the United States are facing important choices that will determine their fiscal and physical viability moving into 2020. Not only is the impetus behind these required changes unclear, many feel that there is a lack of purpose and justification for them, which has resulted in mounting frustration. Read More ›
June 2019, Vol 9, No 6
Healthcare is a highly competitive industry that continues to undergo significant changes, including an increase in digital technologies and other innovations that offer patients new ways to customize their care and find more convenient options for health services tailored to their needs, lifestyles, and finances. As these advancements usher in a new area of healthcare, we need to ask ourselves, “Are we missing the boat?” “Are we about to lose the battle for patient healthcare in the same way that taxis have gradually lost their market for the traveling public to on-demand transportation services such as Uber?” Read More ›
April 2019, Vol 9, No 4
Pharmacy standards will be applied to medical practices, regardless of whether they have a pharmacy licensed with their state Board of Pharmacy. Read More ›
February 2019, Vol 9, No 2
The word on the street is that value-based, or risk-based, oncology contracts for physicians are the inevitable wave of the future. But are they? Read More ›
October 2018, Vol 8, No 10
Pharmacy benefit managers (PBMs) have been seeking greater influence in the oncology market for several years. They are contracted by health plans and employers to manage the drugs covered under pharmacy benefits, which may include newly approved drugs added to the plan; provision of operational controls, such as step edits; prior authorizations; formulary restrictions; and the review of medical necessity for oral medications. Read More ›
November 2016, Vol 6, No 11
The Centers for Medicare & Medicaid Services (CMS) issued its “final” rule in mid-October for the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, and has permanently changed the face of cancer management for the rest of our lives. Read More ›
Innovations in Oncology Management, Vol. 2 No. 2
To discuss the use of specialty pharmacy services, Innovations in Oncology Management™ recently spoke with Dawn Holcombe, President of DGH Consulting, and Executive Director of the Connecticut Oncology Association, who brings 30 years of management experience in hospital, system, network, and physician practices. Read More ›
March 2013, Vol 3, No 2
Health plans and oncology practices alike are evaluating the use of specialty pharmacy as a resource for the delivery of cancer drugs. Specialty pharmacy organizations are creating large divisions to manage oncology spending and to provide not only oral drugs but injectable and infused drugs as well. Read More ›
June 2011, Vol 1, No 2
For the past 4 years, various entities, large and small, have struggled to address the question of guidelines and pathways in oncology. Thousands of hours have been spent building software solutions to the complexity of oncology decision making. Read More ›