Insurers Push to Rein In Spending on Cancer Care
Insurers are changing how they pay for cancer care, aiming to blunt soaring costs and push oncologists to adhere to standardized treatment guidelines. The largest effort yet is set to be unveiled by WellPoint Inc., which will begin offering oncologists a $350-per-month payment for each patient who is on one of the insurer's recommended regimens. WellPoint, the No. 2 insurer in the U.S., will roll out its new program July 1 in six states and through its entire network by the middle of next year. Initially, it will focus on breast, lung and colorectal cancer, but it will expand to other forms of the disease.
Programs like WellPoint's and others around the country are part of an effort to smooth out wide variations in how doctors treat patients, which health experts say can be wasteful and don't always benefit patients. In cancer, insurers and health-care providers have been developing treatment protocols—sometimes known as "pathways"—that are supposed to represent the best and most efficient approaches, balancing cost, benefit and side effects. Insurers are then paying doctors according to how well they comply.
These efforts have the potential to transform the way doctors practice medicine, but they can also spark pushback if they are seen as heavy-handed. Some oncologists worry that moves to standardize treatment could cause tensions as genetics increasingly guide them toward more individualized approaches. Also, there is no widespread agreement about how such programs should work or the exact protocols they should use.
Brian J. Bolwell, chairman of Cleveland Clinic's Taussig Cancer Institute, said the clinic will participate in the WellPoint program "where it makes sense," and the extra $350 payment "is not something we'd ignore." He said WellPoint's clinical recommendations were reasonable, but the clinic is developing its own treatment pathways, and he is concerned about facing different recommendations from each insurer. "We generally don't like to practice by insurance company, we practice by patient," he said.
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Insurers have been experimenting with new payment methods for years. UnitedHealth Group Inc. launched a high-profile project with five oncology practices in 2010 that paid a set chunk of money upfront for each treatment regimen, rather than fees tied to prices of the drugs. The insurer says it now plans to expand that effort, though it will still be a pilot. Cigna Corp. has begun tweaking the reimbursement it pays for drugs that are similar in their uses but have big cost differences. The goal is to ensure doctors earn about the same amount on either drug, so they don't have an incentive to use the pricier one.
Insurers are also starting to fight costs linked to the growing number of tie-ups between oncology practices and hospitals. According to an IMS analysis, average reimbursement for administering cancer drugs is 189% higher in hospital outpatient facilities than in doctors' offices. Often, hospitals have secured more lucrative contracts with insurers, because of stronger market leverage and the higher costs of maintaining their staffs and facilities.
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Sharon Giordano, a professor at MD Anderson Cancer Center, said the WellPoint breast-cancer regimens were "generally reasonable but not comprehensive." Some drugs that she uses "fairly regularly" weren't included, she said, such as Halaven, which she uses in some patients with metastatic disease. Roy Herbst, a professor at Yale School of Medicine, said the lung-cancer treatment recommendations were "reasonable," but he worried that the broader push toward a narrower number of regimens might cut against emerging approaches that personalize treatment based on genetic factors.
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http://online.wsj.com/articles/insurer-to-reward-cancer-doctors-for-adhering-to-regimens-1401220033
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F**k you, WellPoint; F**k you, UnitedHealth and Cigna; F**k you all the for profit insurance companies with your CEOs making millions for "cutting costs" and enriching your shareholders.
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