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How Anthem is realigning the oncology reimbursement system

Staff VP Jennifer Malin says program aims to make care more patient-centered

Cancer treatments costs drain consumers' pockets. Although 13 new cancer treatments have been introduced since 2012, only one extended patients' survival rate by six months. What's more, there's not a single Food and Drug Administration-approved cancer drug for 2015 that is less than $15,000.

The need to overhaul the entire oncology reimbursement system is apparent. That's why Anthem created its Cancer Quality Care Program.

"Our decision to establish our program stemmed from an Institute of Medicine 2013 report that highlighted how care isn't patient-centered enough," Jennifer Malin, staff vice president, clinical strategy, Anthem (pictured right), told FierceHealthPayer. "This report showed that one out of three patients don't receive the best chemotherapy treatment, and that oftentimes, drugs are too toxic. Ultimately, we saw a great need to realign the entire reimbursement system."

Anthem's program pays participating oncologists extra money for treatment planning and care coordination when they select a treatment regime that is "on pathway" or matches Anthem's treatment guidelines.

So far, the program has been implemented in 10 states, noted Malin. By June 1, it will be active in 13 of the 14 Anthem commercial affiliated health plans and is part of the benefit for commercial and Medicare Advantage members.