Overall costs for treating cancer top $100 billion annually, prompting insurers to change how they pay for cancer care to promote evidence-based, cost-effective treatments, The Wall Street Journal reported.
Leading the charge is WellPoint, which will start paying oncologists $350 a month for each patient on one of the insurer's recommended cancer treatment pathways. WellPoint's program will begin July 1 in six states, initially focusing on breast, lung and colorectal cancer, the WSJ noted. It estimates the fully implemented program will reduce cancer treatment costs by about 3 percent to 4 percent.
The Indianapolis-based insurer will still reimburse providers for visits and cancer drugs consistent with a member's health plan terms, but only pathway regimens qualify for the extra payments, WellPoint announced today.
Highlighting the need to support oncologists in identifying highly effective and high-value cancer treatments, WellPoint noted that up to a third of people treated with chemotherapy don't receive a treatment plan in line with medical evidence, while 180 medical journals publishing new cancer studies on a monthly and quarterly basis make it hard to keep up with best practices.
"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," Doug Wenners, WellPoint senior vice president for provider engagement and contracting, said in the announcement.
The Affordable Care Act prohibits insurers from denying cancer patients coverage or charging them much higher rates and guarantees free cancer screenings. But since coverage expansion provisions don't include guaranteed access to specialty cancer hospitals, provider networks on insurance exchanges exclude some of the nation's best cancer hospitals, which concerns some state insurance regulators and patient advocates.
To learn more:
- read the WSJ article (subscription required)
- here's the WellPoint announcement