Is there a better way to manage cancer treatment?
A new study commissioned by Innovent Oncology looks at cancer-related utilization. The study, which was announced today, identifies both regional variation as well as ways to improve quality and efficiency in cancer treatment. Here is an excerpt from the press release:
Innovent Oncology commissioned Milliman’s [Kate] Fitch and co-authors in New York to evaluate 10 of the most common cancer types where chemotherapy is a key treatment modality. The utilization and cost metrics examined include: chemotherapy-related hospitalizations; chemotherapy-related emergency room visits; chemotherapy costs; and end-of-life care including hospice enrollment, death in a hospital and chemotherapy administration within 2 to 4 weeks of dying.
The study used a nationally representative claims database of 14 million commercially insured lives. The 10 cancers identified in the study account for 65% of cancer patients in a commercial population and approximately 25% of these cancer patients received chemotherapy treatment during the observation year. The members receiving chemotherapy and having one of the 10 cancers make up about 0.11% of commercial members, but account for about 4% of overall healthcare costs.
Regional variation is identified with respect to the first three metrics listed above. Chemotherapy-related inpatient admissions and emergency room visits show a two-to-three fold regional difference in rates and chemotherapy drug costs range from $17,000 to $27,000. These regional differences suggest opportunities for health plans and plan sponsors to improve quality, thereby reducing cost and utilization.
Proactive end-of-life care provides patients with higher quality care and both patients and payers with additional quality and cost savings opportunities. For chemotherapy patients with the 10 cancers that were identified as dying in an inpatient setting, 24% received chemotherapy within 14 days of dying and 51% received chemotherapy within 30 days of dying.
“This is a comprehensive commercial payer view of cancer patients receiving chemotherapy and various cost drivers,” says Kate Fitch, RN, MEd, Principal and Healthcare Management Consultant with Milliman. “We are very pleased that Innovent Oncology is publishing this report, especially because there is a growing concern over variation and waste in cancer care.”
While the reasons for variation in chemotherapy prescribing patterns have not been well documented, the benefits of following treatment guidelines, or evidence-based medicine, are well-established including improved outcomes and reduced cost. While some health plans are moving towards managing chemotherapy utilization, few offer incentives to oncologists to show adherence to these treatment guidelines in order to receive reimbursement.
“This study suggests that there are opportunities for better management of chemotherapy patients. I share the belief of many that evidence-based medicine provides the roadmap for physicians and payers to follow,” says Roy Beveridge, M.D., medical director for US Oncology. “Physicians affiliated with Innovent Oncology apply evidence-based medicine, proactive patient management and support, and advance care planning to patient care. This increases the quality and consistency of care received by patients, and aligns incentives to produce better patient outcomes while reducing the overall cost of care.”
Level I Pathways are evidence-based medicine guidelines developed by physician-led committees of disease experts from US Oncology through a consensus building process. Physicians have developed Level I Pathways for the 14 most commonly diagnosed cancers. Physicians choose which treatment is best based on the patient’s needs. Each Pathway is updated regularly as new science reveals better, more appropriate care. These Level I Pathways are available to physicians through affiliation in the United Network of US Oncology or directly through participation in payer sponsored programs through Innovent Oncology.