Hundreds of Georgians have received cancer treatment under a new payment model created by Blue Cross and Blue Shield of Georgia’s parent company. Last...

Hundreds of Georgians have received cancer treatment under a new payment model created by Blue Cross and Blue Shield of Georgia’s parent company.

Dr. Jennifer Malin

Dr. Jennifer Malin

Last year, Georgia was one of six states that Anthem chose to begin the oncology program, which encourages doctors to treat patients under a standardized cancer regimen.

Physicians get extra pay if they choose one of several treatment protocols approved by the insurer.

Anthem said Monday that about two-thirds of patients with colon, breast or lung cancer in the six states were part of the Cancer Care Quality Program, which debuted last July.

The protocols used are recommended as being the best in quality and the most cost-effective, Anthem said.

Physicians are paid an extra $350 management fee per month for each patient on active therapy.

Currently, there is much variation in quality of care in cancer treatment, and costs have soared, Dr. Jennifer Malin, an oncologist and staff vice president for Anthem clinical strategy, said in an interview.

Worldwide spending on cancer medicines reached $100 billion in 2014, an increase of 10.3 percent from 2013 and up from $75 billion five years earlier, according to IMS Health’s Global Oncology Trend Report, released last month.

Some newer cancer drugs can cost more than $100,000 for a round of treatment, the Wall Street Journal reported.

Oncology practices, meanwhile, can get paid a percentage of the cost of drugs they use for patients. That creates an incentive to prescribe the most expensive drugs, Anthem says.

That’s where the management fee comes in.

“So our strategy is to shift reimbursement to give practices the flexibility to be more patient-centered, and not be dependent on drug’’ profits, said Malin of Anthem.

The insurer also noted that as many as one-third of chemotherapy patients do not receive a treatment plan consistent with current medical evidence and “best practices.”

“There’s overtreatment and undertreatment,’’ said Lori McLaughlin, an Anthem spokeswoman. “People are hospitalized with side effects.”

Dr. Frederick Schnell

Dr. Frederick Schnell

The Anthem program is not the only health or government insurer undertaking a payment change around oncology treatment. Medicare will soon offer a care management program as well, said Dr. Frederick Schnell, a Central Georgia oncologist whose practice is applying for the federal program.

Schnell, who is chief medical officer of the Georgia Center for Oncology Research and Education (Georgia CORE),  said Monday that his practice has not joined the Anthem/Blue Cross program so far.

“I was skeptical’’ of the program at first, he said, partly because he felt the drug list was restrictive.

Yet he said that the Anthem initiative “is potentially a step in the right direction. We’re probably going to do it.’’

Such restructuring of doctor and hospital payments is part of the general transformation toward “value-based care,’’ wherein reimbursements are based not on the quantity of services provided, but on the quality of the care. The Affordable Care Act has helped drive this change, and federal health officials have encouraged it when possible.

“Our specialty needs to embrace value-based care,’’ Schnell said. “Until we do, we’re not going to have credibility’’ with health insurers and the federal government, he said.

Anthem’s Malin said the new payment program has created “fairly limited pushback’’ from oncologists. She added that the Anthem drug list does contain some expensive cancer drugs.

Now Anthem has extended the incentive program to 11 types of cancer, and it will be offered by the insurer’s health plans in 13 states.

The insurer does not yet have data on the impact on patients’ health outcomes.

“While it will take time for the program to reach full maturity, we’re encouraged by these results,” Malin said.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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