Insurers Use Incentives to Guide Cancer Treatment Plans

Published Online: May 30, 2014
Katie Sullivan, MA
Beginning July 1, health providers can expect to receive incentives for prescribing specific cancer treatments backed by the insurance company WellPoint. The WellPoint’s innovative program—which will initially focus on breast, lung, and colorectal cancer—will pay providers $350 per patient per month each time they choose 1 of the insurer’s “preferred” cancer treatment options. The company said the financial incentive will encourage providers to choose evidence-based treatments which will reduce patients’ out-of-pocket costs and improve the quality of their care.

“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,” said Doug Wenners, senior vice president for provider engagement and contracting at WellPoint.

The insurer noted that it was necessary to change the way they reimbursed physicians and oncologists due to the rising costs of cancer care in the United States. Last year, cancer drug spending in the United States reached $37 billion.

In an official announcement, the company cited that 1 in 3 patients treated with chemotherapy was receiving treatment plans that were not “consistent with current medical evidence and best practices.” Alone, chemotherapy accounts for 25% of the costs that insured patients who have cancer endure, and that number is growing.

“Oncologist reimbursement at the moment is a broken system,” said Richard Schilsky, MD, chief medical officer of the American Society of Clinical Oncology. He also suggested that WellPoint’s program offered important elements for providers and patients alike.

“We're creating revenue neutrality so better care can be given,” said Dr Schilsky.

While most providers find WellPoint’s proposed system to be reasonable, the recommendations likely wouldn’t be applicable for all.

Sharon Giordano, a professor at MD Anderson Cancer Center at the University of Texas in Houston, described the breast cancer regimens as generally practical, but not comprehensive. She particularly noted that some of drugs she usually prescribes, like Halaven, were not included as part of WellPoint’s preferred offerings.  Roy Herbst, MD, PhD, professor at Yale School of Medicine, echoed similar concern, saying that the program’s narrow regimen offerings might affect patients’ access to more personalized or tailored treatment options.

“There are always going to be unique clinical situations,” said Jennifer Malin, MD, PhD, medical director for oncology for care management with WellPoint. She added that the program will be reviewed and updated on a regular basis.

Around the Web

Insurers Push to Rein In Spending on Cancer Care [The Wall Street Journal]

WellPoint Targets Costly Cancer Care [Fierce Health Payer]

Insurers Push For Doctors To Follow Guided Cancer Treatment Plans [Insurance News Net]