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Dr Lucy Langer: How UnitedHealthcare Is Enhancing Oncology Pathway Adherence and Promoting Equity

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UnitedHealthcare's oncology payment mode initially involved a pay-for-performance program based on pathways adherence, and will be transitioning in 2024 to a broader system with graded quartiles to incentivize greater participation and pathway adherence.

Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare, explains how her organization focuses on ensuring equitable cancer care through non-discriminatory coverage policies and addressing social determinants of health impact.

Transcript

How does your organization's payer model in oncology support or incentivize value-based care, and what have been the key outcomes or challenges you've observed in this regard?

Currently, UnitedHealthcare has a pay-for-performance program that is based on pathways. So, any practice that achieves a threshold level of pathways adherence is eligible for a payment, and that payment is made per pathway selected. All the practices have to do is sign an attestation that they want to participate in the program after they've been told that they qualify for the program. We are evolving that program now to a broader pay-for-performance that we'll be rolling out in 2024, and pathways will be one of the performance metrics. And instead of a threshold, we're going to be using a graded quartile system, so we're hoping that will incentivize more participation and more pathways adherence by paying out incentives even for lower-level participation.

In what ways are you collaborating with health care providers and oncologists to align clinical pathways with value-based care, and what strategies have proven effective in this partnership?

To create our pathways, we have a panel of experts that have been convened by UnitedHealthcare and now Optum, and these experts are well-respected individuals in their field and in their sub-subspecialty of oncology, and they do inform the pathways themselves, so we are using external advisors. And then in my role, I've really started the conversation with oncologists across the country and oncology groups and networks around the need to collaborate, although we haven't yet convened any workgroups or started that work in earnest.

What are some initiatives or programs UnitedHealthcare has undertaken to ensure cancer care is equitable for all patient populations?

In the division that I work in at UnitedHealthcare—the oncology, genomics and laboratory space—we make sure that our coverage policies don't include discriminatory language and are broadly equitable. We are doing more work to examine the impact of social drivers of health, and we're doing work with our Centers of Excellence teams and some of the other teams at UnitedHealthcare to ensure that we are not excluding certain groups or certain regions because of our policies.

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