Bhuvana Sagar, MD: At Cigna, we do have a care coordination model with a patient-centered medical home in place. We do incentivize providers for their adherence to NCCN guidelines, and that is something that we continue to look at to see how we can broaden the scope of it. We’re also looking to see an implementation of pathways in the future, to see if that would add value as well—and how to incentivize them.
Ideally (in lung cancer, for example), it would be great if you can incentivize providers. If they have a patient who has adenocarcinoma, and they’re running mutation studies and treating the patient appropriately based on a mutation study—let’s say the patient has a PD-1 (programmed death-1) status greater than 50% in the first-line setting and they are offered KEYTRUDA [pembrolizumab]. So, the best-case scenario would be to benchmark all of this and understand which providers are following the guidelines and, then, incentivize them. We’re not there yet (at this point), but we are continuing to look at different ways of incentivizing providers to encourage quality care and improve outcomes.
We have not isolated lung cancer in and of itself. It is one of the top 3 cancers in a lot of our population. Overall, it’s either breast, lung, or colon cancer in our demographic population. They get incorporated with the general cancer category and looked at as a broader group (rather than specifically as lung cancer subsets). But what do I think would be good quality measures for lung cancer patients? Ideally, it would be adherence to NCCN guidelines. Are they evaluating the patient’s performance status? Is pain management being done appropriately? Which treatments, ideally, are offering the best chance for overall survival rather than progression-free survival? I think overall survival may be an easier data point to collect than progression-free survival. Those are things that I think would add value, in general. I don’t think, at this point, there are a lot of downsides for us providers, just yet, in terms of overall cost of care. In the near future, when it does happen, providers need to be able to assess their patients and educate their patients before they start patients on therapy.