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Docs say oncologists--not payers--should determine cancer care pathways


Though the concept of designing cancer care "pathways" has potential, oncologists have reason to be concerned about the possibility of health insurers determining these pathways on their own, according to an opinion piece published in JAMA Oncology.

Payers are increasingly looking to cancer care to test payment-reform initiatives. Aetna has created an oncology medical home program that offers enhanced reimbursement to oncology practices that prescribe generic drugs and provide high-quality care. And Anthem's Cancer Care Quality Program works with oncologists to choose a cost-efficient and effective pathway for each patient's treatment regimen, FierceHealthPayer has reported.

There's mounting evidence that the use of oncology pathways can reduce spending on chemotherapy patients, write Blase N. Polite, M.D., Ray D. Page, D.O. and Chadi Nabhan, M.D., noting that a previous study by Blue Cross Blue Shield found such an approach could produce system-wide savings of as much as $30 million.

Despite the concept's promise, Blasé, Polite and Page argue that clinicians, not payers, should be in charge of developing oncology pathways. However, they acknowledge that a completely unregulated pathway environment would be "ineffective at best and unnecessarily burdensome at worst."

So to set clear standards, they suggest the creation of flexible criteria similar to what the Centers for Medicare & Medicaid Services uses for its Qualified Clinical Data Registry Reporting. A variety of stakeholders--including payers, physicians and patient advocates--would determine that criteria. If a pathway meets that threshold criteria, all public and private payers would be required to accept it.

In addition to the promise of cost savings, oncology pathways also can improve the use of high-value and evidence-based care, the authors conclude. So now is the time "to bring order to the pathway world before it becomes engrained in the market and the ability to regulate it is diminished."

To learn more:
- read the opinion piece

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Anthem, UnitedHealth experiment with value-based oncology payment models