UnitedHealthcare's cancer protocol reports essentially 'policing' docs

While it may be advantageous to have doctors receive reports on whether the cancer treatment they prescribe follows quality protocols, UnitedHealthcare's recent move to mail individualized reports to physicians raises the question of whether a company with a financial stake should be working to police doctors.

"This is one area I'd rather have doctors police themselves than have an insurance company do it," says Eric Winer, chief scientific adviser for Susan G. Komen for the Cure, a research and educational organization.

UnitedHealthcare has started sending individual reports to physicians assessing treatment of breast, lung, and colorectal cancer patients. Cancer, by cost, is UnitedHealthcare's third-most expensive disease at $2.5 billion a year, ranking behind cardiovascular disease and orthopedic joint procedures.

"Oncology has always been the third rail for managed care," says Lee Newcomer, Unitedhealthcare's senior vice president of oncology. "Insurance companies have been very reluctant to get involved in cancer care because any management might be perceived as denial."

The company says its goal its to draw physicians' attention to how treatments comply or vary with accepted protocol. That attention could reduce unnecessary care and reduce costs. The American Society of Clinical Oncology has been running its own quality-assessment program, and the group is seeking to enlist the help of insurers to expand the number of participating physicians.

UnitedHealthcare's work is the first tracking and reporting to doctors about cancer treatments, and it shows that while colorectal and lung cancer patients are more apt to receive treatment not recommended by experts, breast cancer patients generally have care that conforms to protocols.

To learn more:
- read the Wall Street Journal article