Cancer Treatments: Enhanced Care or Better Reimbursements?
WellPoint, one of the nation’s leading health benefits companies, announced a new program it was putting in place regarding cancer patients and the care they receive. The problem is, it looks like two entirely different programs, depending on which side from which you’re viewing it.
The program, which is being implemented in just six states, could be expanded nationwide. Ohio is one of the states Medicare Advantage members will be part of the program.
But what is and who does it really benefit?
In a Wall Street Journal, column, Anna Wilde Matthews explains that oncologists, if they wish to make an additional $350 a month, will be putting their cancer patients on one of the insurer’s predefined regimens. Currently, those with breast, lung and colon cancer are being targeted. The goal, according to the report, is to “standardize treatment plans”.
Richard Schilsky, Chief Medical Officer of the American Society of Clinical Oncology, explains, “Oncologist reimbursement at the moment is a broken system. While the WellPoint plan contains many of the important elements you’d like to see in a novel reimbursement strategy, the tension between personalized medicine and standardized care is tangible.”
For its part, WellPoint insists that identifying certain cancer treatment pathways selected based upon current medical evidence, peer-reviewed published literature, consensus guidelines and its own policies, will provide better support for oncologists looking to identify those cancer therapies that will be both “highly effective” while also providing greater care.
The program, explains Dr. Jennifer Malin, the WellPoint oncology medical director, will allow for better sharing of information, evidence based practices and stronger support for those with larger staffs. This, she said, will help reimburse those doctors who wish to “offset the lower fees received when prescribing less expensive drugs”.
The insurer estimates this new program will save $5.4 billion per year, which equates to around 4% of all cancer treatment costs. Many physicians concur that the guidelines are reasonable; however, even more insist many of the more routine – and successful – drugs are not included on the approved list. As mentioned, Ohio is one of the trial states and so far, we know that Cleveland Clinic is one of the approved facilities that will take part in the pilot program. Despite Taussig Cancer Institute Chairman Brian J. Bolwell’s assertion that, “We don’t generally like to practice by insurance company. We practice by patient” assertion, he says this program “makes sense”.
WellPoint isn’t the first insurance company to put into place a program such as this. Both Cigna and UnitedHealthcare (along with several more) have already instituted their own plans for reducing waste and “streamlining” physicians’ efforts. The problem is, new medical research has consistently being suggesting very unique genetics associated with every cancer in every patient. The challenge is going to be to ensure each patient is treated as uniquely as his diagnosis. That’s where many are concerned.
Some are already asking whether or not doctors will abandon their experimental and daring efforts if it means losing out on a monthly incentive. Even if it is just $350 a month.
We encourage our clients who are concerned about these new policies and how they will affect their elder care and Medicaid or Medicare coverage to contact our office. In the meantime, we will continue to monitor these new policies.