UnitedHealthcare to Expand Existing Bundled Payment Model in Oncology

Now that UnitedHealthcare has reported monetary success with its bundled pilot program that was launched in 5 oncology practices in 2010, its time to reproduce the success, identify ways to reduce prescription drug spend (which actually increased in the pilot), and analyze the impact on quality of care. The health plan has announced 2 programs: an expansion of the existing pilot program which will include the addition of 5 more oncology practices and 550 oncologists, and a chemotherapy-approval program for real-time decision support and approvals based on the National Comprehensive Cancer Network (NCCN) Guidelines.

Published in the Journal of Oncology Practice earlier this year, the company’s pilot study reported savings of nearly $33.4 million over the 3-year study period. At the recently held Payer Summit, hosted by the Community Oncology Alliance, Lee Newcomer, MD, MHA, senior vice president at UnitedHealthcare said about their pilot, “We are very encouraged by this project that there are opportunities for savings. No matter the approach, community oncologists have the opportunity to be rewarded for the value they bring.” At the meeting, Newcomer spoke to these expansion plans, informing the audience that Texas Oncology had joined the program in January, along with 4 other practices nationwide: Rocky Mountain Cancer Centers, Colorado; OHC, Specialists in Cancer and Blood Disorders, Ohio; Cancer Specialists of North Florida; and Tulsa Cancer Institute, Oklahoma.

“We look forward to working with additional medical practices to expand our efforts to identify best practices for treating cancer and deliver effective science-based care to more people who are dealing with this complex disease,” said Newcomer in the press release.

With respect to tools for decision making and approval, UnitedHealthcare has developed a fast-track drug approval program that verifies benefits coverage in real-time for regimens that meet NCCN Guidelines for injectable chemotherapy medications administered in the outpatient setting. Developed in collaboration with eviCore Healthcare, it is expected to ensure faster patient access.