In order to better understand oncologists’ perceptions of the impact of the Affordable Care Act (ACA) on their practice and investigate expectations regarding new cancer treatments, pathways, and reimbursements for 2015, InCrowd launched a microsurvey. We surveyed 100 board certified and US licensed oncologists from across the US that treat between 100 and 500 patients per month, and have been practicing medicine for between 3 and 25 years. They primarily treat breast, lung, prostate, or colon cancer patients and have reported that their practice has already been or will be impacted by the ACA in 2015 Early results show oncologists are generally concerned with the implementation of the ACA adversely effecting their patients and practice, however the full implications have yet to be realized. To learn more about InCrowd, visit us at www.incrowdnow.com.

1. Microsyndicated Report:
Oncologists’ Perceptions of the ACA’s
Impact and Expectations for 2015
Fielded November 3-5, 2014
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Methodology – Five Question Microsurvey
2
Objective:
– To better understand oncologists’ perceptions of the impact of the Affordable Care
Act (ACA) on their practice and investigate expectations regarding new cancer
treatments, pathways, and reimbursements for 2015.
Primary Takeaway:
– Early results show oncologists are generally concerned with the implementation of
the ACA adversely effecting their patients and practice, however the full implications
have yet to be realized.
Methodology:
– Data collected via InCrowd’s microresearch application from November 3rd to 5th 2014
– Sample of 100 oncologists from across the US that:
• Are board certified and licensed in the US, treating between 100 and 500 patients per
month, and have been practicing medicine for between 3 and 25 years
• Are primarily treating breast, lung, prostate, or colon cancer patients
• Reported their practice has already been or will be impacted by the ACA in 2015

3. Key Findings
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 ACA Impact: Nearly two-thirds (64%) of oncologists who entered
the survey have already been impacted by the ACA, while one-fifth
(21%) expect it will impact their practice in 2015; 15%
report that their practice has not been impacted by the ACA and
don’t expect the law to impact their practice over the next year.
 Over one-fifth (22%) of oncologists cite decreasing income and
reimbursements as the most prevalent effect of the ACA on their
practice so far.
 While 19% of oncologists also mention a general shift
among patients into insurance plans with narrower
networks, limited coverage, or Medicaid.
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 2015 Pipeline Expectations: New immunotherapies and targeted biologics, including PD-1/PD-L1
inhibitors, are their most anticipated treatment developments for 2015.
 2015 Oncology Pathways Expectations: Oncologists are generally apprehensive about treatment
pathways, with about a quarter expressing concern that pathways will ultimately limit their treatment
autonomy to the detriment of their patients’.
 Some oncologists also worry that pathways may have a negative impact on personalized or
precision medicine and will pressure cancer patients to pursue less expensive and less effective
treatments.

4. Key Findings - Continued
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 2015 Reimbursement Challenges: About 4 out of 10 oncologists
believe reimbursements and income will (continue to) decline
over 2015.
 While nearly a fifth of oncologists anticipate no new major
challenges regarding reimbursements in 2015.
 Concerns over pathway-related penalties and smaller
margins on chemotherapy (and other drugs) are other
reimbursement-related concerns.
4
 ACA-Related Effects: Approximately 7 out of 10 oncologists agree that the ACA has resulted in more
paperwork and a greater regulatory burden for their practice, has caused concern about the end of
the 2014 enhanced Medicaid reimbursement rates, and has driven more cancer patients to avoid or
defer needed treatment due to increases in patient cost burdens.
 Oncologists are largely divided on the effectiveness of bundled payments, or episode-based
payments, as a means of improving the quality of healthcare delivered, controlling costs by
incentivizing coordinated care, and making their practice more financially viable.
 Oncologists operating within a private practice are less likely than those operating within health
systems to agree that their patient load has increased or that bundled payments or covered clinical
trials are beneficial to their practices and patients.

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Nearly two-thirds of all oncologists who entered the survey have already been
impacted by the ACA, while one-fifth expect it will impact their practice in 2015
Impact of the ACA on Oncologists
14%
22%
28%
21%
15%
Over one-third of oncologists
report the ACA has had
moderate to high impact on
their practices
A great deal of impact
Somewhat of an impact
A little bit of an impact
No impact yet, but
expected in 2015
No impact at all and none
expected (screened out)
S1: In your opinion, how much of an impact has the Affordable Care Act (ACA) had on your practice, if any at all? n=118 5

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The majority of oncologists interviewed operate within an independent private
practice setting and almost half work primarily with breast cancer patients
Primary Oncology Focus
Mean
Pts/Month
Breast Cancer 67
47%
Lung Cancer 35
24%
Prostate Cancer 73
18%
Colon Cancer 34
PCP Practice Arrangement / Autonomy
14%
2%
24% 60%
Independent private practice (standalone, group single-, or group
multi-specialty)
Affiliated with or part of a loosely controlled health system (i.e.,
central or controlling board makes recommendations, but
decisions are largely left to practices)
Owned by a tightly controlled health system (i.e., central or
controlling board dictates formulary, pathway, and procedural
decisions that must be adhered to)
Other
11%
S2: Which of the following best describes your current practice setting / arrangement?
S3: For which of the following cancers do you see/treat the most patients in a typical month as a medical oncologist? n=100 6

7. Oncologists operating in tightly controlled health systems are significantly more likely to
have already been impacted by the ACA, with half reporting mod to high impact
Impact of the ACA by Oncology Practice Arrangement
A/B/C - indicates group result is significantly higher than designated group at a 90% confidence interval
S1: In your opinion, how much of an impact has the Affordable Care Act (ACA) had on your practice, if any at all?
Overall n=100; Private Practice n=60
S2: Which of the following best describes your current practice setting / arrangement? Loose System n=24; Tight System n=14
7
(Among Those Currently or Expecting Impact)
23%
38%
7%
37%
21%
43%
27%
21%
29%
13%
21% 21%
(A)
Independent
Private Practice
(B)
Part of a Loosely
Controlled Health System
(C)
Owned by a Tightly
Controlled Health System
High Impact
Moderate Impact
Low Impact
Impact Expected in
2015
40%
42% 50%
C
C
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Decreasing income/reimbursements and more patients shifting to plans with narrower networks, more
limited coverage, or Medicaid are among the most mentioned prevalent effects of the ACA according to
oncologists
Most Current or Expected Prevalent Effect of the ACA on Oncology Practices
(Number of Mentions)
Decreased income/reimbursements
Patient loss due to and general shift to narrower networks, limited
coverage, and Medicaid expansion
Anticipating major changes/impact, but currently unaffected
Increased patient volume / More insured individuals
Less time for patient care / Patient care limited indirectly by ACA
requirements
Increases to patient cost share
(e.g., high deductibles, out-of-pocket, drug costs, etc.)
More insurance hassles
(e.g., more denials, prior authorization issues, referral issues, etc.)
Increased confusion or uncertainty due to insurance changes
Increases to paperwork, bureaucracy, admin, and practice overhead
Other
Unsure of when or what impact will be
22
19
17
15
11
9
9
9
8
8
7
Other mentions:
• Patients are dissatisfied
• Increased income/reimbursements
• Hospital consolidation / Shift to
hospital employment
S1: In the comment box below, please describe what you believe has been or will be the ACA’s most prevalent effect on your practice. n=100 8

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New immunotherapies and targeted biologics, including PD-L1/PD-1 inhibitors, are by
far the most anticipated oncology treatment developments for 2015
Most Anticipated Oncology Treatments or Products for 2015
(Number of Mentions)
PD-L1/PD-1 inhibitors
New immunotherapies
New targeted biologic or biosimilar therapies /
Molecular profiling
Not sure / None / Nothing in particular
Specific products
Histone deacetylase inhibitors
Better cancer-specific treatments
Better or new alternative therapies
Other
Better testing and preventative care
33
15
14
12
8
5
5
3
3
2
Specific treatments mentioned:
• Palbociclib
• LHRH & taxotere combo treatments
• Tasquinimod in mCRPC
• Keytruda
• Bevacizumab
• Nivolumab
• Kadcyla
Alternative therapies mentioned:
• Thermal / photon oncology
• New radiation therapies
• Improved androgen therapies
• Other non-traditional therapies
Q1a: What new cancer treatment options, drugs or other oncology products are you most looking forward to in 2015? n=100 9

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Oncologists are generally apprehensive about treatment pathways, with concerns about their potentially
negative impacts on oncologists’ treatment autonomy, personalized or precision medicine, and their
patients’ cancer treatment decisions
Anticipated Effects of Oncology Treatment Pathways in 2015
(Number of Mentions)
Restricts ability to do my job / Limits treatment autonomy
None / No impact
Less personalized or precision medicine
Patients will pursue more inexpensive, but less effective treatments
Other
Pathways already in place / No new effects
Small, largely negative impact
Will be forced on us and mandated by penalties
Not Sure / Unclear
Patients will avoid or be denied needed treatment
Will become the new norm in oncology treatment
Great, largely negative impact
More paperwork & bureaucratic hassle
General diminishing returns / Less income or reimbursement
24
12
11
11
11
9
8
8
8
5
5
4
4
3
Other pathway-related comments:
• Will not adopt pathways in 2015
• Should adopt NCCN guidelines
• Will encourage targeted agent
development
• Open to pathways/generally positive
• Will encourage molecular profiling
• Will improve treatment efficiency
• Will decrease use of biologics
Q1b: How, if at all, do you anticipate oncology treatment pathways will affect your practice in 2015? n=100 10

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The most prominent reimbursement challenge anticipated by oncologists for 2015 is the continuing decline
of reimbursements themselves, typically cited as “indirectly” related to the ACA and its impact on the
industry as a whole; however, about one-fifth anticipate no new or major reimbursement challenges
Anticipated Reimbursement Challenges and Changes for 2015
(Number of Mentions)
Declining reimbursements/income
No major impact/new challenges expected
Inadequate chemotherapy coverage / Smaller margins on chemotherapy
Will be increasingly restricted to specific pathways due to penalties or prior
authorization issues / Less freedom to choose best treatments
Not sure
Increases to patient cost share
(e.g., high deductibles, out-of-pocket, drug costs)
More patients with limited coverage seeking to pay less
(e.g., fewer visits, avoiding/deferring treatment)
Pressure to sell practice (due to cost shift) or become hospital employee
Other
Substantial increase to challenges, paperwork, and burden related to
insurance companies
Inadequate reimbursement due to Medicare sequestration
More bundled payments and other alternative reimbursement models
39
19
13
10
9
7
7
6
5
4
3
3
Other reimbursement-related comments:
• Arbitrary quality-based reimbursements
and incentives
• Timelier payments
• Less coverage for PET scans
Q1c: Please explain any significant reimbursement challenges you anticipate in 2015 and whether or not they relate to the ACA? n=100 11

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Around 7 out of 10 oncologists agree that the ACA has resulted in more paperwork and a greater regulatory
burden for their practice, has left them concerned about Medicaid reimbursement rates, and has driven
more cancer patients to avoid or defer needed treatment due to an increased cost burden
ACA Impact Statement Agreement
The ACA has resulted in considerably more paperwork and a
35%
37%
16%
12%
Mean
greater regulatory burden for my practice 2.04
I am worried about the end of the enhanced 2014 Medicaid
reimbursement rate 2.07
An increase in patient cost sharing, such as higher deductibles or
out-of-pocket costs, have caused more cancer patients to defer or
avoid needed treatments
2.20
Incentivizing reimbursements for treatment regimens that follow
specific pathways identified by insurers ultimately reduces the
quality of patient care
2.45
Bundled payments help to improve the quality of healthcare
delivered, while controlling costs by financially incentivizing
coordinated care
3.15
Increased access to primary care and preventative services will go
32%
28%
20%
10%
40%
39%
37%
22%
16%
19%
25%
24%
12%
15%
16%
28%
2%
15%
a long way to reducing the incidence of many cancers 2.95
The ACA’s required coverage for clinical trials of cancer treatments
10%
8%
32%
25%
20%
39%
27%
20%
10%
7%
have been a significant boon for some of my patients 2.93
Due to the ACA, our patient volume has increased significantly
since the beginning of 2014 3.06
Bundled payments, or episode-based payments, (can) make my
7%
28%
30%
22%
13%
4%
24%
29%
27%
16%
3.27
practice more financially viable or secure 1 - Strongly Agree 2 - Somewhat Agree 3 - Neither Agree nor Disagree 4 - Somewhat Disagree 5 - Strongly Disagree
Q2: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the following statements. (5-point scale) n=92-100 12

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Though most oncologists recognize ACA-related increases to paperwork, regulatory burdens, and patient
cost sharing regardless of their practice type, independents are less likely to agree that their patient load has
increased or that bundled payments or covered clinical trials are beneficial to their practices and patients
ACA Impact Statement Agreement by Practice Arrangement
Overall
Mean
Independent
Private Practice
(A)
The ACA has resulted in considerably more paperwork and a greater
regulatory burden for my practice 2.04 2.02 1.82 2.50
I am worried about the end of the enhanced 2014 Medicaid reimbursement
rate 2.07 2.04 2.13 2.23
An increase in patient cost sharing, such as higher deductibles or out-of-pocket
costs, have caused more cancer patients to defer or avoid needed
treatments
2.20 2.05 2.48 2.38
Incentivizing reimbursements for treatment regimens that follow specific
pathways identified by insurers ultimately reduces the quality of patient care 2.45 2.41 2.16 2.85
The ACA’s required coverage for clinical trials of cancer treatments have
been a significant boon for some of my patients 2.93 3.09 C 2.86 2.31
Increased access to primary care and preventative services will go a long way
to reducing the incidence of many cancers 2.95 3.03 2.71 2.92
Due to the ACA, our patient volume has increased significantly since the
beginning of 2014 3.06 3.28 BC 2.75 2.64
Bundled payments, or episode-based payments, help to improve the quality
of healthcare delivered, while controlling costs through financially
incentivizing coordinated care
3.15 3.35 C 2.96 2.58
Bundled payments, or episode-based payments, (can) make my practice
more financially viable or secure 3.27 3.38 3.25 2.79
Relatively More Agreement Relatively Less Agreement
A/B/C - indicates group result is significantly higher than designated group at a 90% confidence interval
Q2: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the
Loosely Controlled
Health System
(B)
Tightly Controlled
Health System
(C)
Overall n=92-100; Private Practice n=56-60;
Loose System n=19-24; Tight System n=12-14
following statements. (5-pt scale, 1=Strongly Agree to 5=Strongly Disagree) 13

14. Moderately and highly impacted oncologists seem more likely to agree that the ACA has resulted in more
paperwork and a greater regulatory burden for their practices and that they are concerned about the end of
the enhanced 2014 Medicaid reimbursement rate
ACA Impact Statement Agreement by Degree of Impact
Q2: Please consider the impact of the ACA on your practice and indicate how much you agree or disagree with each of the
Overall n=92-100; Low n=30-33;
following statements. (5-pt scale, 1=Strongly Agree to 5=Strongly Disagree) Mod n=24-26; High n=14-16; In 2015 n=22-25
14
Overall
Mean
Low Impact
Moderate
Impact
High Impact
Impact in
2015
The ACA has resulted in considerably more paperwork and a greater
regulatory burden for my practice 2.04 2.19 1.84 1.80 2.22
I am worried about the end of the enhanced 2014 Medicaid reimbursement
rate 2.07 2.23 1.96 1.79 2.16
An increase in patient cost sharing, such as higher deductibles or out-of-pocket
costs, have caused more cancer patients to defer or avoid needed
treatments
2.20 2.31 2.00 2.12 2.32
Incentivizing reimbursements for treatment regimens that follow specific
pathways identified by insurers ultimately reduces the quality of patient care 2.45 2.68 2.46 2.47 2.09
The ACA’s required coverage for clinical trials of cancer treatments have
been a significant boon for some of my patients 2.93 3.03 3.20 2.53 2.76
Increased access to primary care and preventative services will go a long way
to reducing the incidence of many cancers 2.95 2.97 3.08 2.81 2.88
Due to the ACA, our patient volume has increased significantly since the
beginning of 2014 3.06 3.15 3.04 3.00 3.00
Bundled payments, or episode-based payments, help to improve the quality
of healthcare delivered, while controlling costs through financially
incentivizing coordinated care
3.15 3.33 3.17 3.00 3.00
Bundled payments, or episode-based payments, (can) make my practice
more financially viable or secure 3.27 3.24 3.19 3.50 3.24
Relatively More Agreement Relatively Less Agreement
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15. Mark Antonacci
InCrowd, Inc.
mark.antonacci@incrowdnow.com
973.432.6381 | www.incrowdnow.com