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UnitedHealthcare expands Episode Payment Program that rewards
physicians for better cancer care
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Online chemotherapy approval process speeds access to
life-saving cancer treatment
UnitedHealthcare is advancing new approaches to cancer treatment with
two groundbreaking programs that help put patients’ needs at the center
of care.
UnitedHealthcare is expanding its pioneering cancer care payment model,
first launched in 2010, that rewards physicians for focusing on quality
patient care, best treatment practices and health outcomes. A study
published in the Journal
of Oncology Practice demonstrated this program reduced overall
cancer expenses by more than a third while improving quality outcomes.
Five additional oncology practices – including 550 oncologists – are now
joining the program, bringing the total number of oncologists to
approximately 650 in seven states.
Additionally, UnitedHealthcare is launching a first-of-its-kind
chemotherapy approval program that will provide real-time decision
support and approvals for therapies based on National Comprehensive
Cancer Network® (NCCN®) treatment recommendations from the NCCN Clinical
Practice Guidelines in Oncology (NCCN Guidelines®). NCCN is the leading
independent source for clinical recommendations that guide chemotherapy
treatments. UnitedHealthcare provides online displays of all recommended
treatments for a patient’s specific condition during the approval
process, accelerating access to life-saving treatments for people with
cancer and helping speed coverage approvals.
Both programs underscore UnitedHealthcare’s commitment to new approaches
to cancer care that encourage best practices for effective treatment in
cancer care.
Fast-Track Drug Approval Program
The fast-track drug
approval program gives oncologists a new way to get to “yes” with an
intuitive online tool that quickly verifies benefits coverage for drug
regimens that meet NCCN Guidelines for injectable chemotherapy drugs
administered on an outpatient basis. Real-time approvals are possible
because the tool automatically populates the NCCN-recommended treatments
based on the patient’s specific clinical condition. Once the physician
confirms the treatment is consistent with NCCN Guidelines,
UnitedHealthcare issues an immediate coverage approval. This ensures the
patient gets fast access to the best treatment. The tool was developed
by NCCN and eviCore Healthcare.
“This new online tool tailors recommendations to the patient’s specific
condition,” said Lee Newcomer, M.D., UnitedHealthcare senior vice
president of oncology. “In many cases, patients can now get
instantaneous approval for their treatments because the smart technology
automatically links the relevant cancer treatment guidelines with the
requested chemotherapy.”
Since the program was launched in June, UnitedHealthcare has completed
more than 17,000 reviews with only one appeal. Among those reviews,
physicians received an instant approval for nearly 70 percent of the
requests. Only 1 percent of the requests were not approved by the end of
the process.
Some requests may require additional clinical information or review by
an oncologist, but are still completed within three business days or
less.
“NCCN is dedicated to advancing high-quality, high-value cancer care
through the publication of evidence-based treatment recommendations that
enable clinicians to work alongside their patients to make well-informed
treatment choices,” said Robert W. Carlson, M.D., CEO of NCCN. “We
commend UnitedHealthcare’s effort to accelerate patients’ access to the
best and most appropriate care available based on their individual
clinical conditions as outlined by the NCCN Guidelines.”
UnitedHealthcare has been using this new online tool in a pilot program
in Florida since May 2014. Physician response to the Florida pilot has
been favorable, with some oncologists describing the new process as “the
most logical, easy-to-use and appropriate system in the market.”
The online tool also will help advance cancer research and patient care
by building a database that will enable UnitedHealthcare to analyze
comparative effectiveness among different chemotherapy treatments for
the same type of cancer; the company expects to publish the first
comparative-effectiveness results in two years.
Episode Payment Program Leads to Better Care for Patients
UnitedHealthcare
is expanding its episode cancer care payment initiative, another program
to improve cancer care treatment. The program pays participating medical
oncologists more if they demonstrate superior clinical results and
reduce the total costs of care.
The episode payment model shifts reimbursement away from the current
“fee-for-service” approach that emphasizes volume of care delivered
regardless of a patient’s health outcomes. The episode payment is based
on the expected cost of a standard treatment regimen for the specific
condition, as predetermined by the doctor. Similar payment models have
shown to enhance care coordination and improve health outcomes for
patients, while reducing overall costs.
UnitedHealthcare first implemented its episode payment program between
October 2009 and December 2012 in a pilot study, which produced a
significant reduction in hospitalizations for patients and a 34 percent
reduction in total costs while improving quality. Click here
to read results of the study.
The more than 550 physicians joining the program are from five practices
nationwide: Texas Oncology, with multiple locations in Texas; Rocky
Mountain Cancer Centers, with multiple locations in Colorado; OHC,
Specialists in Cancer and Blood Disorders in Cincinnati; Cancer
Specialists of North Florida with multiple locations in Florida; and
Tulsa Cancer Institute in Tulsa, Okla.
“We applaud UnitedHealthcare for enhancing its cancer care payment
approach,” said E. Randolph Broun, M.D., president and chairman of OHC.
“Our partnership complements our mission of ensuring that patients
receive optimal care, when and where they need it, and in the most
cost-effective manner.”
UnitedHealthcare’s episode payment initiative is part of a growing
national movement to explore new care and payment models. This marks the
program’s second expansion, following the successful
pilot that began with five oncology groups and a second
pilot established at MD Anderson in December 2014.
“This streamlined payment process, coupled with oncologists sharing best
practices and learning from one another, put patients’ interests at the
forefront of cancer treatment,” said Dr. Newcomer. “It also results in
significant cost savings. 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.”
About UnitedHealthcare
UnitedHealthcare
is dedicated to helping people nationwide live healthier lives by
simplifying the health care experience, meeting consumer health and
wellness needs, and sustaining trusted relationships with care
providers. The company offers the full spectrum of health benefit
programs for individuals, employers, military service members, retirees
and their families, and Medicare and Medicaid beneficiaries, and
contracts directly with more than 850,000 physicians and care
professionals, and 6,000 hospitals and other care facilities nationwide.
UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE:
UNH), a diversified Fortune 50 health and well-being company. For more
information, visit UnitedHealthcare at www.uhc.com
or follow @myUHC
on Twitter.
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