Guest Column

Here’s why you should care about CON Commission’s efforts

November 8, 2019
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For more than eight years, I have had the privilege of serving Michigan citizens as a commissioner representing the business community on the Certificate of Need (CON) Commission. The purpose of CON is to review the most complex health care services and technology to balance cost, quality and access for Michigan residents. There is an effort underway to undermine this work, and I hope you will hear me out on why you should care.

Thirty-five other states have a CON Commission, but unless you work in the administration side of health care, chances are you have never heard of it. For transparency's sake, I am a free market, limited-regulation Republican. The company I founded and am proud to have grown in Michigan is fortunate to work for some of Michigan’s finest employers. My company’s mission is to negotiate for clients’ health benefits that embrace quality and value and fight against rising health care costs.

Almost always, I believe we suffer from excessive government regulation. If health care was a free market in the United States, the CON Commission would not be necessary. But until consumers of health care services are responsible for the costs of transactions when seeking services, there needs to be minimum oversight to ensure against inappropriate utilization of services.

The CON Commission regulates a small number of health services, but they are the most complex and expensive treatments, such as open-heart surgery, bone marrow transplants and organ transplants, to name a few. In the last few years, a specialty cancer treatment called CAR-T therapy has made its way into cancer treatment protocols for leukemia and lymphoma. CAR-T is a type of treatment in which a patient's T cells (a type of immune cell) are removed and changed in the laboratory so they will attack cancer cells.

It is an extremely expensive treatment, ranging from $400,000 to $700,000 just for the CAR-T therapy product. Thousands of more dollars are spent on the process of follow-up care. As the patient receives the new altered cells, there is a reaction in their body that has to be carefully managed. If additional steroid treatment is not timed perfectly, all of the cancer will not be killed or the patient’s organ can be destroyed. This is why training and experience are so important.

CAR-T therapy is new and has not been regulated by the CON Commission before. Due to the high cost and expertise needed to administer CAR- T therapy, the CON Commission thought it imperative to review its regulations.

The CON Commission sanctioned a diverse group of leading oncologists, CAR-T experts and industry representatives representing hospitals that currently administer CAR-T therapy and those that do not offer this cutting-edge technology to study the issue in depth.

After over a year of review, they made a recommendation to the CON Commission. They unanimously recommended no limit on the number of health care facilities administering CAR-T therapy; however, they also recommended a quality standard known as FACT accreditation.

FACT is a peer-review process that requires providers to maintain the highest level of quality for patients. FACT requires that providers follow a patient’s health status for life. If you or someone in your family had cancer and were getting CAR-T therapy, I am confident you would want them treated by physicians and hospitals committed to maintaining the highest quality standards and that were open to having their cases reviewed by experts in the field of cellular therapy/CAR-T.

There is an effort to set aside this requirement in the Michigan Legislature, led by strong special interests from the pharmaceutical industry who do not want any oversight of how their products are administered. We cannot let drug companies dictate our state’s health policies. This is why I am standing with doctors and insisting that patients be protected; I hope you will join me.

Robert Hughes is president and founder of Advantage Benefits Group in Grand Rapids.

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