Affiliated health plans of WellPoint, Inc. 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 WellPoint subsidiary, AIM Specialty Health, identifies certain cancer treatment pathways selected based upon current medical evidence, peer-reviewed published literature, consensus guidelines, and WellPoint’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 distributers. 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 Dr. Jennifer Malin, WellPoint oncology medical director.
The program will be implemented first in Indiana, Kentucky, Missouri, Ohio, Wisconsin, and Georgia with plans to expand to health plans in other states throughout 2014 and 2015. 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 Doug Wenners, WellPoint senior vice president for provider engagement and contracting, who leads provider collaboration. “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 WellPoint, Inc.
WellPoint is one of the nation’s leading health benefits companies. We believe that our health connects us all. So we focus on being a valued health partner and delivering quality products and services that give members access to the care they need. With nearly 67 million people served by our affiliated companies including nearly 37 million enrolled in our family of health plans, we can make a real difference to meet the needs of our diverse customers. We’re an independent licensee of the Blue Cross and Blue Shield Association. We serve members as the Blue Cross licensee for California; and as the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In most of these service areas, our plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia and Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). We also serve customers in other states through our Amerigroup and CareMore subsidiaries. To find out more about us, go to wellpoint.com.
- Health Care Industry
Lori McLaughlin, 317.407.7403