Anthem sees promise in oncology payment reform initiative

Amid rising concern about sky-high costs and a sometimes-adversarial relationship between insurers and oncologists, Anthem is seeking to change the status quo with its Cancer Care Quality Program.

Essentially, the program is a payment reform initiative that collaborates with oncologists to improve the quality and lower the cost of cancer care, Jennifer Malin, M.D., a medical oncologist and staff vice president for Clinical Strategy at Anthem, explains in an interview with the Oncology Times.

Anthem allows oncologists entered in the program to choose a "pathway" for a patient's treatment regimen. The insurer currently has developed pathways for nearly 20 different types of cancer, has rolled out the program in 14 states, and has opened it up to all lines of business except Medicaid, Malin says.

Anthem selects these pathways once it determines that they are the most cost-efficient and effective regimens--i.e. those that provide the best toxicity profile. Still, oncologists aren't required to select a pathway regimen in cases where it isn't warranted, Malin notes.

Anthem chose this particular model, she says, because it doesn't require oncology practices to have a specific type of technology or electronic medical record system. "We wanted to make our program something that any practice could participate in--the large groups as well as the one- and two-person practices."

Based on preliminary data, Anthem has found that the still-new program has led to increased pathway adherence among oncologists among in its networks, from 40-50 percent to 60-65 percent, according to Malin. The insurer doesn't yet have data on how the program has affected cost of care.

Anthem will stick with its current program rather than the Centers for Medicare & Medicaid's new Oncology Care Model or the American Society of Clinical Oncology's own payment reform initiative, Malin adds, in part because the company believes its plan is the most feasible.

"But I do think there is definitely a recognition among all the payers that we need to have consistent approaches to measuring quality and value," she adds.

To learn more:
- here's the interview

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