Affiliated health plans of WellPoint, Inc. will be introducing an
innovative quality initiative beginning July 1 that will allow
oncologists to compare planned cancer treatment regimens against
evidence-based clinical criteria and potentially receive enhanced
reimbursement.
The WellPoint Cancer Care Quality Program, developed in collaboration
with WellPoint subsidiary, AIM Specialty Health, identifies certain
cancer treatment pathways selected based upon current medical evidence,
peer-reviewed published literature, consensus guidelines, and
WellPoint’s clinical policies, to support oncologists in identifying
cancer treatment therapies that are highly effective and provide greater
value.
Today, cancer care is challenged by the following:
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Up to 1 in 3 people treated with chemotherapy do not receive a
treatment plan that is consistent with current medical evidence and
best practices.1
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Costs of new cancer therapies are growing by 25 percent annually.2
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As many as 180 medical journals publish new studies on cancer monthly
and quarterly, making it difficult for oncologists to stay up-to-date.
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Cancer drugs – unlike other therapies – are purchased directly by
practices and hospitals from manufacturers or distributers. Health
insurers generally reimburse practices a set percentage above the cost
of the drug.
“This program – while sharing best practices and evidence-based medicine
– also helps to support oncologists who require large staffs to treat
these complex patients and provides the practice with enhanced
reimbursement to offset the lower fees they receive when prescribing
less expensive drugs,” said Dr. Jennifer Malin, WellPoint oncology
medical director.
The program will be implemented first in Indiana, Kentucky, Missouri,
Ohio, Wisconsin, and Georgia with plans to expand to health plans in
other states throughout 2014 and 2015. All fully-insured and
self-insured members, Medicare Advantage members and national account
members who live in states where the program has been implemented are
part of this program.
Providers will continue to be reimbursed for visits and cancer drugs
according to the terms of the member’s health plan regardless of whether
a treatment is on pathway, however, only pathway regimens are eligible
for enhanced reimbursement.
“Chemotherapy makes up 25 percent of the costs to treat health plan
members who have cancer, and this percentage is growing faster than any
other part of care,” said Doug Wenners, WellPoint senior vice president
for provider engagement and contracting, who leads provider
collaboration. “It’s clear that our approach to cancer therapy is the
answer in making a positive impact on quality and in slowing the rate of
these increases to keep premiums as affordable as possible.”
1.Wu 2012, Bilimoria 2009, Spencer 2008, Neuss 2013, Malin
2006
2.Express Scripts, Drug Trend Report 2013, page 25.
About WellPoint, Inc.
WellPoint is one of the nation’s leading health benefits companies. We
believe that our health connects us all. So we focus on being a valued
health partner and delivering quality products and services that give
members access to the care they need. With nearly 67 million people
served by our affiliated companies including nearly 37 million enrolled
in our family of health plans, we can make a real difference to meet the
needs of our diverse customers. We’re an independent licensee of the
Blue Cross and Blue Shield Association. We serve members as the Blue
Cross licensee for California; and as the Blue Cross and Blue Shield
licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine,
Missouri (excluding 30 counties in the Kansas City area), Nevada, New
Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New
York City metropolitan and surrounding counties and as the Blue Cross or
Blue Cross Blue Shield licensee in selected upstate counties only),
Ohio, Virginia (excluding the Northern Virginia suburbs of Washington,
D.C.), and Wisconsin. In most of these service areas, our plans do
business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue
Cross and Blue Shield of Georgia and Empire Blue Cross Blue Shield, or
Empire Blue Cross (in the New York service areas). We also serve
customers in other states through our Amerigroup and CareMore
subsidiaries. To find out more about us, go to wellpoint.com.
Copyright Business Wire 2014