Private Payers and Cancer Care: Revisiting the Land of Opportunity.

Ten years ago we charted a course for oncology payment reform. We summarize what went wrong and propose ways to fix it.

Evolving strategies for the management of multiple myeloma: a managed care perspective.

Current challenges in the management of multiple myeloma (MM) include the changing treatment landscape and the need for better care coordination and improved communication. A roundtable meeting involving key stakeholders (physicians, nurses, pharmacists, managed care professionals, pharmaceutical industry professionals, and patient care advocates) was held to discuss challenges in the management of MM and evolving strategies to address these challenges and improve quality of care for patients with MM. Interventions discussed included the use of a treatment pathway to standardize treatment, decrease costs, and possibly increase efficacy by encouraging adherence to treatment guidelines whenever possible, and the use of an oncology medical home (OMH) to facilitate communication among treatment providers. Challenges to the successful implementation of treatment pathways include the rapid introduction of new therapies and the need to balance efficacy and value. It was stressed that treatment pathways must not prioritize profits over the health and welfare of the patient. Considerations related to the implementation of the OMH include the identification of appropriate measures to evaluate quality, value, and outcomes, and the provider implementation costs related to the OMH model.

Opening the black box: the impact of an oncology management program consisting of level I pathways and an outbound nurse call system.

PURPOSE: The Innovent Oncology Program aims to improve the value of cancer care delivered to patients. McKesson Specialty Health and Texas Oncology (TXO) collaborated with Aetna to launch a pilot program. The study objectives were to evaluate the impact of Innovent on Level I Pathway compliance, implement the Patient Support Services program, and measure the rate and costs associated with chemotherapy-related emergency room (ER) visits and hospital admissions. PATIENTS AND METHODS: This was a prospective, nonrandomized evaluation of patients enrolled in Innovent from June 1, 2010, through May 31, 2012. Data from the iKnowMed electronic health record, the McKesson Specialty Health financial data warehouse, and Aetna claims data warehouse were analyzed. RESULTS: A total of 221 patients were included and stratified according to disease and age groups; 76% of ordered regimens were on pathway; 24% were off pathway. Pathway adherence improved from TXO baseline adherence of 63%. Of the 221 patients, 81% enrolled in PSS. Within the breast, colorectal, and lung cancer groups, 14% and 24% of patients had an ER visit and in-patient admission (IPA; baseline) versus 10% and 18% in Innovent, respectively; average in-patient days decreased from 2.1 to 1.2 days, respectively. Total savings combined for the program was $506,481. CONCLUSION: Implementation of Innovent positively affected patient care in several ways: Fewer ER visits and IPAs occurred, in-patient days decreased, cancer-related use costs were reduced, and on-pathway adherence increased.

Private payers and cancer care: land of opportunity.

The costs of cancer care are unsustainable in the present US health care system. Private payers have taken a leading role in oncology payment reform. This benefits all payers, including the Center for Medicare and Medicaid Services (CMS). Private payers' ability to set up systems of measurement and quality improvement is a strategy to support pay-for-value contracting. This facilitates workflow changes in oncology office practice as a way to bend the cost trends while enhancing patient care. Oncology practitioners demand speed and flexibility in deploying customized information technology solutions in exchange for new contracting terms. Pathway and guideline support tools have been proven effective in validating the use of evidence-based medicine and in systematizing office operations to reduce avoidable costs. The future of oncology practice should see further enhancement of these capabilities. A common health information exchange pipeline will allow patients, physicians, and other health care providers to share structured information from multiple electronic medical record/electronic health record platforms. By allowing multiple payers, including CMS, to access commonly accepted clinical decision support rules, any payer can create contracts and relationships with oncology practices. In this manner, future changes in payment for oncology services mandated by CMS can be sustained within the infrastructures being built today through payer-provider collaborations.

Defining Value in Cancer Care: AVBCC 2012 Steering Committee Report.

Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28-31, 2012, for the Second Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancer care and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancer care continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancer care collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancer care and articulated action steps that can help to implement value into cancer care delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD.