WellPoint's move to offer oncologists monthly payments of $350 for each patient treated in compliance with one of the insurer's recommended treatment pathways is the latest effort from an insurer to reign in the costs of cancer care.
According to a Wall Street Journal report, WellPoint will begin the new program July 1 in six states and through its entire network by mid-2015. The program's initial focus will rest on breast, lung and colorectal cancers. The pathways, also known as treatment protocols, were developed with guidance from oncology groups and outside experts.
WellPoint's program has already caught the attention of one prominent cancer institution: Cleveland Clinic's Taussig Cancer Institute. Brian Bolwell, MD, chairman of the institute, told WSJ the clinic will participate in the new program "where it makes sense" and an extra $350-per-month payment to oncologists "is not something we'd ignore," according to the report.
Still, the idea of strict adherence to treatment pathways causes some physicians and clinicians worry about depersonalization of medicine. Although Dr. Bolwell said WellPoint's clinical pathways are reasonable, he expressed concern about complying with different clinical recommendations from each payer. Ultimately, he said the organization likes to practice based on its patients, not insurance companies.
WellPoint expects its recommendations to apply to approximately 80 percent to 90 percent of patients. Oncologists face no penalties for using other treatments. When the new program is fully implemented across the WellPoint network, the insurer has estimated savings of 3 percent to 4 percent of cancer treatment costs, which total around $5.4 billion a year for its fully insured business, according to the report.
Traditionally, payers and providers have been more cautious to manage the costs of cancer care compared to other conditions and specialties. Oncology is highly specialized and sophisticated: There are more than 200 types of cancer, not to mention the specialty's cutting-edge technology, newly approved drugs, continual study findings and groundbreaking treatment options. Cancer is also an emotionally charged disease. Questioning the medical necessity of services in pediatrics and oncology was long treated as a last resort, given the likelihood of negative publicity.
But in light of healthcare's gradual but steady move from fee-for-service to pay-for-performance, insurers and providers are more willing to meet each other halfway when it comes to cancer care and costs. Whether through clinical protocols, provider-patient counseling sessions, genetic testing or oncology-specific accountable care organizations and bundled payments, oncology presents several collaborative opportunities for providers and payers to better align incentives.
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