Title: Oncology Treatment Pathways Program
Organization: CareFirst BlueCross and BlueShield and Cardinal Health
Innovation Type: Evidence Based Clinical Practice Support
What They’re Doing: Evidence Based Clinical Practice Support with support from Pay for Performance in the form of enhanced payments for cognitive services.
Clinical Innovation: Physicians receive information on preferred treatment pathways for specific cancer diagnoses, as developed by a panel of community and academic oncologists. In April 2011, CareFirst introduced its Oncology Comprehensive Care Management Program , which seeks to refine and connect treatments and processes to improve quality of care and patient outcomes. The expanded program extends beyond standard treatment regimens to include end-of-life care, resource management and quality measures that complement CareFirst’s Primary Medical Home Program. Physicians are required to enter clinical information on the different measures into the program’s electronic portal. Program nurses then review the submissions and works with physician practices to keep them informed of their compliance rates and relevant financial metrics and help them employ strategies for improvement. The program also offers guidance in providing supportive care to patients suffering side effects of cancer treatment, such as neutropenia, anemia, nausea and vomiting.
Supportive Financing Mechanism: Physicians who achieve an 80% rate of compliance with the preferred pathway treatment and supportive recommendations receive an enhanced reimbursement rate throughout the year.
Evaluation Type: Non-Experimental .
Evaluation Plan: CareFirst tracks patient outcomes, physician adherence to pathway, and financial metrics of 200 oncologists in the program compared to 200 oncologists not participating in the program.
Patient Health and Cost Outcomes:
Reduced Costs: Tracked the cost savings by comparing the overall cost per patient for each specific cancer type in the participating groups vs. the non-participating. In year #1, the Oncology Treatment Pathways group showed a 7% increase in cost per patient, vs. a 15% increase in cost per patient in the non-participating group.
Physician compliance with the recommended pathways was on average 85% by the participating group, complared to med 60's for the non-participating
In year #2, there was 100% compliance with the recommended pathways in the participating group, compared to mid 60's for the non-participating
Results for the expanded Oncology Comprehensive Care Magagement Program that launched in April
Target Population: The Program is open to physicians participating in CareFirst networks providing care to CareFirst members with the Program's stated cancer diagnoses.
Date of Implentation: The original program was launched in August 2008 while the expanded program launched in April 2011.
Contact: Dr. Daniel Winn, DrDaniel.Winn@carefirst.com
Where to learn more: Please contact Dr. Winn.