Episode 9 - Analyzing Incentive Programs

Together, experts Peter Salgo, MD; John L. Fox, MD, MHA; Ira M. Klein, MD, MBA, FACP; Michael Kolodziej, MD; and Bryan Loy, MD, analyze programs that are aimed at helping to control the high costs associated with the treatment of cancer while driving quality.

Dr Loy explains that collaboration between payers and organizations such as ASCO and NCCN continues to be a success. As these organizations continue to update and/or establish new guidelines, they are very receptive to feedback and use the information to modify their recommendations, he says. Dr Loy adds that specific programs such as the work of the National Business Group on Health ensure that large employers also have the opportunity to share considerations with payers in terms of how the cancer experience affects them.

Because treatment complications are a major concern, the establishment of specific pathways can help limit the number of adverse events and guide therapy; and the use of pathways is particularly beneficial because they can help guide care in cancers where several treatment options are available, says Dr Fox.

In addition to these considerations, the panelists also consider the effects of reimbursement programs such as WellPoint’s (Anthem’s) initiative to reimburse oncologists who following planned treatment regimens in an effort to save on costs and drive quality. As a competitor, Dr Kolodziej provides an overview of the initiative, analyzes its usefulness, and highlights the factors that challenge its success.

Despite these controversies, Dr Loy notes that initiatives such as the WellPoint (Anthem) initiative are not a waste, and it’s important to try to learn from each model.

Dr Fox explains that reimbursement programs aim to defer healthcare professionals from relying on a margin of drugs to fund their practice. However, Drs Kolodziej and Salgo point out evidence, as demonstrated in the results of a UnitedHealthcare study, that argue that despite beliefs, oncologists are in fact making therapeutic decisions outside of these margins.

Drs Klein and Loy further explore the results of the study. Despite its limitations, the experts highlight the positive elements that were determined as a result of the study.