ST. LOUIS--(BUSINESS WIRE)--
Anthem Blue Cross and Blue Shield in Missouri will be introducing an innovative quality initiative beginning July 1 that will allow oncologists to compare planned cancer treatment regimens against evidence-based clinical criteria and potentially receive enhanced reimbursement.
The WellPoint Cancer Care Quality Program, developed in collaboration with AIM Specialty Health, a separate company, identifies certain cancer treatment pathways selected based upon current medical evidence, peer-reviewed published literature, consensus guidelines, and Anthem’s clinical policies, to support oncologists in identifying cancer treatment therapies that are highly effective and provide greater value.
Today, cancer care is challenged by the following:
- Up to 1 in 3 people treated with chemotherapy do not receive a treatment plan that is consistent with current medical evidence and best practices.1
- Costs of new cancer therapies are growing by 25 percent annually.2
- As many as 180 medical journals publish new studies on cancer monthly and quarterly, making it difficult for oncologists to stay up-to-date.
- Cancer drugs – unlike other therapies – are purchased directly by practices and hospitals from manufacturers or distributors. Health insurers generally reimburse practices a set percentage above the cost of the drug.
“This program – while sharing best practices and evidence-based medicine – also helps to support oncologists who require large staffs to treat these complex patients and provides the practice with enhanced reimbursement to offset the lower fees they receive when prescribing less expensive drugs,” said Wayne Meyer, M.D., medical director of Anthem Blue Cross and Blue Shield in Missouri.
All fully-insured and self-insured members, Medicare Advantage members and national account members who live in states where the program has been implemented are part of this program.
Providers will continue to be reimbursed for visits and cancer drugs according to the terms of the member’s health plan regardless of whether a treatment is on pathway, however, only pathway regimens are eligible for enhanced reimbursement.
“Chemotherapy makes up 25 percent of the costs to treat health plan members who have cancer, and this percentage is growing faster than any other part of care,” said Dr. Meyer. “It’s clear that our approach to cancer therapy is the answer in making a positive impact on quality and in slowing the rate of these increases to keep premiums as affordable as possible.”
1. Wu 2012, Bilimoria 2009, Spencer 2008, Neuss 2013, Malin 2006
2. Express Scripts, Drug Trend Report 2013, page 25.
About Anthem Blue Cross and Blue Shield in Missouri
In Missouri (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Missouri is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.
- Health Care Industry
- Blue Cross and Blue Shield
Deborah Wiethop, 314-923-4767