US Oncology's Payer Quality Services Aims High

Adhering to established treatment guidelines is an important component of ensuring optimum care for patients with cancer. It is also becoming increasingly important as a way for physicians to ensure that they receive the optimum level of reimbursement for the services they provide. To help physicians manage the complexities of meeting benchmarks and reporting their compliance to payers, US Oncology recently announced Payer Quality Services. This program will give physicians in the United Network of US Oncology access to a collection of resources and tools, including the Level I Pathways Program. These evidence-based guidelines and operating procedures for treating the 14 most commonly diagnosed cancers are available electronically through iKnowMed, US Oncology’s Web-based electronic health records (EHR) system, and the Innovent Oncology Portal. Participating oncologists will have access to this clinical quality benchmarking program and to patient and referring physician loyalty survey programs. They can also request on-site or remote support with payer negotiations.

Bruce Broussard, chairman and CEO of US Oncology, said in a press release, “Our new Payer Quality Services offering brings to bear the managed care and pay-for-performance expertise of US Oncology to help community oncology practices effectively collaborate with payers to align the interests of the patient, payer, and physician.”

Broussard said the US Oncology network has amassed years of experience and derived insight from participation in pay-for-performance contractual relationships involving nearly 20% of the network’s physicians and 6 million covered lives in the country, making it uniquely qualified to launch this initiative.

The Need for a New System

A growing number of insurers are instituting pay-for-performance initiatives in the United States. Michael Kolodziej, MD, is a physician at New York Oncology Hematology, Albany Medical Center, a US Oncology affiliate. Kolodziej was one of several physicians involved in the program’s development.

“Pay-for-performance is here to stay,” said Kolodziej. He noted that many current programs have not clearly demonstrated that they can control costs without compromising the quality of care, and they rely on benchmarks that have not been validated as indicators of improved patient outcomes.

“We needed a system that would measurably improve the quality of care by providers, and that would help to lower costs by addressing the key factors driving up healthcare costs—mainly treatment variability and unscheduled hospitalizations and emergency room visits,” Kolodziej explained. “US Oncology’s Level I Pathways is one of the few evidence-based guideline programs that considers cost, after ensuring high-quality patient care by adhering to the best available evidence.”

Terry Kopp, vice president of Innovent Oncology, a wholly owned subsidiary of US Oncology, agreed that the new system is greatly needed. “The current environment where physicians are reimbursed largely based on drug utilization is not sustainable,” he said. Innovent Oncology manages the Level I Pathways program and provides proactive patient support and advance care planning to address key drivers in quality and cost of cancer care.

Kopp said the Payer Quality Services program works to align financial incentives with better patient care, which is something oncologists in the US Oncology network support. The Payer Quality Services program uses US Oncology’s Level I Pathways, which incorporate evidenced-based treatment algorithms that factor cost into consideration when there is no difference in efficacy and toxicity between recommended therapies. The program also includes processes to present Level I Pathways at the point-of-care, ensuring that workflow is not interrupted and allowing for feedback on adherence. This helps guarantee that patients receive the best care based on available science. Kolodziej listed other potential benefits of the Level I Pathways program: “Reduced medical errors, streamlined inventory and improved operational efficiencies, and certainly financial benefits to patients who face big coinsurance bills.” The savings for patients, said Kolodziej, could run into the thousands of dollars.

Payers (public and private) often have their own individual benchmark programs for physicians, and many payers are concerned that having physicians operate under multiple clinical benchmarking programs could lead to confusion. There is also concern that some of these programs emphasize cost over other aspects of care. “While payers recognize that adopting different standards is not efficient for practices, some are more focused on reduced cost today as an interim step to better management,” Kopp said. He believes widespread adoption by oncologists of US Oncology’s Level I Pathways, which include standards for quality of care, could increase the likelihood that multiple payers will accept them for their benchmark programs. Kopp said US Oncology’s Payer Quality Services ultimately will help clinicians improve patient care and survival and increase the efficiency of their practice. He added, “Physicians will have to take a greater role advocating for benchmarks and standards that produce better patient outcomes and survival.”

Caring for the Whole Patient

Kopp noted that a unique aspect of the Innovent Oncology program and the Level I Pathways is that they were “developed by physicians, administered by physicians, and managed at the practice level by physicians.” Thus, it is one of the few initiatives for managing cancer care that considers every aspect of the cancer care continuum. “We believe that it is appropriate to reimburse and incentivize physicians to be proactive in all aspects of patient care to provide for the patient’s entire medical needs,” Kopp said.

Cancer

Most patients would likely agree with Kopp. Data from multiple studies have demonstrated that a cancer patient’s emotional wellbeing has a direct effect on his or her physical wellbeing. A 2009 retrospective study published in the journal , for example, reported that death rates were as much as 25% higher for patients with symptoms of depression; and the Childhood Cancer Survivors Study recently reported that young adults who survived childhood cancers are four times more likely to develop post-traumatic stress disorder.

Kopp said the Innovent Oncology approach has been validated in a study with Aetna and the Milliman report, which “suggest that programs like Innovent Oncology can impact variation in care and produce equal clinical outcomes.” According to Kopp, programs that do not have provisions for managing all aspects of the patient’s care—including complications that occur between chemotherapy treatments—are not as likely to have a lasting impact or create value for patients.

Kopp added that the system also benefits patients’ families and caregivers by involving them in early discussions about end-of-life care, and invites more physician involvement in care for patients with late-stage disease. He said this is a win-win for everyone involved. Studies have shown that discussing end-of-life care can reduce the unnecessary expense and unpleasant effects of ineffective treatments given in the last few weeks of life, resulting in better quality of life for patients and their caregivers prior to the patient’s death. Even experienced oncologists can have difficulty with these sensitive conversations, and no doubt many would welcome the support.

Joining US Oncology Network Even Easier

US Oncology has made it easier for community-based oncology practices to join its United Network of US Oncology through its Targeted Physician Services offering. This provides a number of standard and optional benefits for practices while allowing clinicians to remain independent.

Oncology practices that join through Targeted Physician Services or form a Comprehensive Strategic Alliance relationship will have access to the Level I Pathways, the iKnowMed EHR system, and the Payer Quality Services program. In addition, they will be able to connect with other oncologists in the network through the Oncology Portal to discuss difficult cases or get information on new developments in cancer care.