Though this is an era in which there is increasing momentum behind alternative payment models, it is still challenging for insurers to determine value for "transformational improvement" in the field of cancer care.
That said, payers may need to change how they reward innovation, especially given the budget-busting effects of pricey new cancer drugs, Michael Kolodziej, M.D., Aetna's national medical director for oncology solutions, told Managed Care Magazine in an interview.
Encouraging value in cancer care delivery is at the forefront of Aetna's oncology medical home program, which the insurer designed based on what it learned from its primary care medical home program, Kolodziej says. In the short term, the program offers enhanced reimbursement to oncology practices that prescribe generic drugs and provide high-quality care that keeps patients out of the hospital and emergency department.
Aetna has submitted an application to the Centers for Medicare & Medicaid Services' Oncology Care Model program to bring 10 new practices into the program, which has about 17 practices currently. Eventually, Kolodziej hopes to use the information from the oncology medical homes to determine the cost components of what an episode of care should look like, he says.
Kolodziej notes that due to doctors' innate individualism, they sometimes balk at such care standardization, thinking that it constitutes "cookie-cutter medicine." But the key there is to distinguish care personalization--a positive practice--with variation. The latter, he argues, almost never yields a superior result.
Aetna is not the only insurer to jump into oncology payment reform. Anthem's Cancer Care Quality Program works with oncologists to choose a cost-efficient and effective "pathway" for each patient's treatment regimen, and the program so far has produced promising results, FierceHealthPayer has reported.
To learn more:
- here's the interview with Dr. Kolodziej
Aetna's oncology medical home will 'define the value of care'
Anthem sees promise in oncology payment reform initiative
CMS aims to change how providers, payers pay for cancer treatment
Anthem, UnitedHealth experiment with value-based oncology payment models
Providers can no longer ignore rising cancer costs