First oncology value-based payment model used nationally by major health insurers
CHICAGO—June 1, 2015—A new cancer quality initiative and payment model developed to improve cancer outcomes and promote access to evidence-based and cost-effective care is taking hold with oncologists, according to data from a presentation today by Anthem, Inc. at the American Society of Clinical Oncology Annual Meeting.
The Cancer Care Quality Program is the first oncology value-based payment model to be used by a group of health insurers for almost all of their commercial and Medicare Advantage members.
Approximately two-thirds of patients with colon, breast and non-small cell lung cancer were registered with the Cancer Care Quality Program, based on chemotherapy claims data. This figure increases to more than 78 percent when considering those practices that had at least one patient registered within the program.
Seventy-two percent of registered patients with colon cancer were being treated with a therapy designated on pathway and recommended by Anthem as one of the regimens most likely to produce the best outcomes, the fewest side effects and the most cost-effective care. Sixty-three percent of those with breast cancer were on pathway and 63 percent of those with non-small lung cancer were on pathway.
The pathway data is based on data submitted by the practices through a web portal to AIM Specialty Health, the administrator of the program. Anthem anticipates that about 85 percent of all chemotherapy requests for registered patients will be on pathway when the program is fully mature.
“While it will take time for the program to reach full maturity, we’re encouraged by these results,” said Dr. Jennifer Malin, staff vice president for Anthem clinical strategy. “It demonstrates that oncologists are not only open to considering pathways, but that they often agree with the pathways on the best treatment for their patients. Some practices were on pathway for almost every patient.”
The Anthem cancer treatment pathways are based on the medical evidence that analyzes outcomes related to clinical benefit, both survival and quality of life, toxicity, strength of national guideline recommendations and lastly, costs are considered when clinical outcomes among therapies are equivalent. They are reviewed by external advisors that consist of about dozen geographically diverse physicians who are actively treating patients and work in academic and community oncology groups and have specific interest in quality of care.
Since the first rollout of the program in Indiana, Kentucky, Missouri, Ohio, Wisconsin, and Georgia in July, 2014, the program has expanded to include other cancers, such as ovarian, pancreatic, leukemia, lymphoma, melanoma, myeloma, prostate and cancers that impact the central nervous system. By July 1, the program will be implemented for patients and providers in 13 states.
Oncology practices provide clinical data on biomarkers, performance status and planned treatment into the Cancer Care Quality Program platform, administered and developed in collaboration with AIM Specialty Health. Oncologists who participate in the program and choose one of the possible cancer treatment pathways based on the latest medical evidence are eligible to receive an additional $350 payment for treatment planning and care coordination for each month the patient is in active therapy. Those who do not choose a pathway, as well as those who do, continue to be reimbursed for drug purchase and administration as they have previously.
Rates of participation and pathway adherence for the abstract study results were estimated based on clinical and claims data. The poster is authored by Anthem’s Dr. Malin and Ann Nguyen; AIM’s Dr. Stacey Ban, Paula Inches, Boris Spevak, and Dr. Michael Fisch; and HealthCore’s Vince Willey, John Barron and Ralph Quimbo.
About Anthem, Inc.
Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With nearly 71 million people served by its affiliated companies, including more than 38 million enrolled in its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit www.antheminc.com/companies
Media contact:Lori McLaughlin 317.407.7403 moc.mehtna@2nilhguaLcM.iroL