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Highmark unveils bundled-payment model for cancer care


Following in the footsteps of other major insurers, Highmark will debut a bundled-payment initiative aimed at paying for value in cancer care, according to the Pittsburgh Post-Gazette.

The insurer's new bundled payment option includes 19 cancers that are treated with medication as well as radiation treatment for breast cancer. Instead of requiring doctors to obtain pre-authorization for care, Highmark pays them a lump sum that it negotiates individually with each doctor based on past payments to that doctor, the article says.

"They can treat the patient as they see appropriate because the health plan is stepping out of the middle," Virginia Calega, Highmark's vice president of medical management and policy, tells the Post-Gazette.

Already, more doctors have applied to participate in the bundled-payment initiative than the insurer can accommodate, according to Tom Pellathy, senior vice president of product network and reimbursement at Highmark.

Providers in the program are required to use National Comprehensive Cancer Care Network treatment guidelines, but they can use their discretion in how those guidelines are used, Pellathy adds.

The initiative is a part of a partnership with Allegheny Health Network and Johns Hopkins Kimmel Cancer Center, called the Highmark Cancer Collaborative. Highmark's regional rival, UPMC Health Plan, wants to debut its own bundled-payment cancer-care initiative later this year, according to the article.

Anthem, UnitedHealth and Aetna each have their own versions of value-based oncology payment models, and the federal government recently debuted new payment model proposals for Medicare Part B, which covers treatments provided at medical facilities, including many cancer treatments.

Oncologists have been highly critical of the Medicare Part B proposals, though, saying they prioritize cost-cutting over patients' best interests. They also have argued that providers, not private payers, should be in charge of developing set clinical pathways for cancer care.

To learn more:
- read the article

Related Articles:
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Aetna's oncology medical home will 'define the value of care'
Anthem, UnitedHealth experiment with value-based oncology payment models
Docs say oncologists--not payers--should determine cancer care pathways
Feds to test new Medicare Part B payment models