Achieving balance: Providing high-value cancer care

Eighteen million. That’s the number of people who will call themselves cancer survivors in 2020, according to the National Cancer Institute. This is a 30% increase in cancer survivors since 2010. 

While the increased numbers surviving this disease should indeed be celebrated, the cost of treating cancer patients has skyrocketed. The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) says that the cost of treating cancer in 2011 was $88.7 billion. By way of contrast, the National Institutes of Health projects that if newly developed tools for diagnosis, treatment, and follow-up continue to increase in cost, treating cancer in this country could top $207 billion in 2020.

“This is not unexpected due to the U.S. demographics and medical treatment advances since unlocking the human genome,” says Randy Vogenberg, partner at Access Market Intelligence and cofounder of the National Institute of Collaborative Healthcare in Greenville, South Carolina. “The ramping up of investments in healthcare technologies combined with the added boomers’ aging population to the aged population growth rates create a perfect storm for escalating healthcare costs that will significantly challenge patients, providers, and payers of all types.”

UnitedHealthcare and other payers such as Anthem, Inc., and Cigna have developed a series of cancer care plans in an attempt to encourage providers to adhere to evidence-based practices while monitoring (and hopefully leading to a decrease in) treatment costs.

MalinIn July, Anthem introduced its Cancer Care Quality program to oncology practices in the Midwest and Georgia; and the program is scheduled to roll out in Virginia in October. The Cancer Care Quality program includes a series of pathways-or best practices based on the National Comprehensive Cancer Network (NCCN) and other guidelines-for treating nearly 20 different types of cancer, says Jennifer Malin, MD, staff vice president of clinical strategy at Anthem. “When the oncologist uses a particular pathway, they’re eligible for billing for $350 more each month,” she says. “That helps with treatment planning coordination.”

The goal of Anthem’s pathways program is to help ensure that members have access to quality, evidence-based affordable healthcare, says Malin. “More cost-effective and clinically proven treatments typically mean lower drug costs or fewer hospitalizations due to toxicity. If so, savings like this allow us to keep premiums more affordable for members.”

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