Collaborative, coordinated care is the catchphrase of the decade in healthcare, but for cancer patients one area of Western Pennsylvania, it has become much more.
With the launch of the new Highmark Cancer Collaborative, payers and providers are working together in a new way, removing barriers that for too long have prevented true progress in affordable and accessible cancer care.
David S. Parda, MD, FACP, professor and system chair of the department of oncology and the Cancer Institute at Allegheny Health Network (AHN), which is part of the collaborative, says he hopes the partnership will help overcome what the Institute of Medicine (IOM) calls a “cancer care crisis” in the United States.
In a September 2013 report, IOM wrote that despite remarkable advances in cancer care over the last 50 years—leading to a nearly 70% cure rate—cancer care is still inadequate and being delivered at unsustainable costs.
“We agree with this assessment and the tough solutions that are required. We need to improve patient-centered, accessible, coordinated, and evidence-based treatment and care. We need to increase the focus on prevention and psychosocial wellness as some estimates indicate that 50% of cancers may be preventable,” Parda says.
The collaborative is made up of a partnership between AHN, Highmark Blue Cross Blue Shield, and the Johns Hopkins Sidney Kimmel Comprehensive Cancer.
The premise is that Highmark is providing AHN physicians with a system for identifying evidence-based cancer care pathways based on patients’ individual information. Incentives for ineffective, or unproven treatments are removed and instead value-based care is pursued. Highmark is also removing pre-authorizations for cancer patients, and it is streamlining the claims and payment process to help providers get paid faster.
AHN and Highmark will focus on bringing experts together to advance cancer care on all levels—quality of care, access, experience and value for all stakeholders, says Parda.
Cancer patients can be sure that they get the most appropriate earliest treatment by getting a second opinion or confirmation of their cancer diagnosis and staging by specialists at Johns Hopkins. Johns Hopkins is also collaborating on patient cases—particularly in rare or complex cases—through direct physician peer-to-peer review and other virtual methods. It also offers joint educational programs, and participation in collaborative research projects and clinical trials.
Terry Langbaum, MHS, chief administrative office at Johns Hopkins Kimmel Cancer Center, says Johns Hopkins has had a partnership with AHN for the past two years, but the new collaboration expands the possibilities. “We are bringing together a lot of assets and all working together toward better outcomes for cancer patients,” Langbaum says.
Patients will not necessarily receive treatment at Johns Hopkins—which sees 8,000 new cancer patients each year—with the exception of rare or complex cancers, or patients who are eligible and elect to participate in a clinical trial. The majority of cancer care can and should be delivered at facilities within the patient’s community, like at AHN, she says.
“Really the whole point of it is to make sure each patient has the right diagnosis and right stage to drive the correct treatment plan, and that they are getting their treatment in the right place,” Langbaum says.