ABSTRACT
The Wilshire Oncology Medical Group developed a medical oncology home pilot to offer a transparent, high-quality, high-value cancer program in partnership with its largest California health plan, Anthem Blue Cross WellPoint.
Subject(s)
Cooperative Behavior , Insurance, Health, Reimbursement/economics , Medical Oncology/economics , Neoplasms/economics , Practice Patterns, Physicians'/statistics & numerical data , Primary Health Care/statistics & numerical data , Delivery of Health Care , Electronic Health Records/economics , Electronic Health Records/statistics & numerical data , Geography , Health Care Costs , Health Maintenance Organizations/economics , Health Maintenance Organizations/statistics & numerical data , Humans , Insurance, Health, Reimbursement/statistics & numerical data , Medical Oncology/statistics & numerical data , Neoplasms/drug therapy , Patient Care/economics , Patient Care/statistics & numerical data , Pilot Projects , Practice Patterns, Physicians'/economics , Primary Health Care/economics , United StatesABSTRACT
PURPOSE: With the advent of newer cancer therapies (eg, biologic and cytotoxic), treatment is becoming increasingly expensive for patients with cancer. Patients enrolled in Medicare and commercial insurance plans often have large copay requirements with each treatment cycle. Often, these patients undergo significant financial hardship, and some patients decline treatment. We have developed a support program that works closely with all copay assistance foundations to secure financial assistance to facilitate appropriate treatment. METHODS: In September, 2008 we initiated a coordinated program with various copay assistance foundations, including Healthwell, Cancer Care, Patient Access, Chronic Disease Fund, Beckstrand Cancer, Lilly Cares and the Leukemia and Lymphoma Society. Patients requesting assistance with chemotherapy copay were enrolled in this program. Information about income level, chemotherapy regimens, and associated copay was given to these foundations, who then determined the amount of monetary assistance. RESULTS: Since the initiation of this program, of 201 patients who began receiving chemotherapy, 25 (12.4%) requested assistance with this program for either intravenous or oral treatments. The current results of time delays for foundation decision, success rates and administrative costs to secure funding will be presented at the time of the poster presentation. CONCLUSION: Copay for chemotherapy drugs is a financial hardship for a significant number of patients. Coordinated resources must be provided and reimbursed to facilitate appropriate and sustainable cancer care. This program is a successful model for other centers to adopt.
