WellPoint's Enhanced Payment Plan Encourages Following Treatment Protocols

Tony Berberabe, MPH @OncBiz_Wiz
Published: Wednesday, May 28, 2014

A new reimbursement program initiated by WellPoint, Inc., looks to pay oncologists an additional $350 a month for each patient who is enrolled in and follows one of the insurer’s recommended cancer treatment regimens, according to an article in The Wall Street Journal. The article reports that the new program will be rolled out July 1 in Indiana, Kentucky, Missouri, Ohio, Wisconsin, and Georgia, and throughout WellPoint’s entire network by the middle of next year. WellPoint is the second largest insurer in the United States.

The WellPoint Cancer Care Quality Program, developed in collaboration with WellPoint subsidiary, AIM Specialty Health, identifies certain cancer treatment pathways selected based upon current medical evidence, peer-reviewed published literature, consensus guidelines, and WellPoint’s clinical policies, to support oncologists in identifying cancer treatment therapies that are highly effective and provide greater value. WellPoint says the program will focus on breast, lung and colorectal cancer, but it will expand to other forms of the disease.

In the article, Richard Schilsky, MD, chief medical officer of the American Society of Clinical Oncology (ASCO), said the WellPoint program contains "many of the important elements you'd like to see" in a pathways initiative.

Oncologists seek reimbursement from private insurers and Medicare. He said ASCO “has its own Medicare payment reform proposal that would try to ensure oncologists are reimbursed in ways that fund such services as phone calls with patients.”

“This program—while sharing best practices and evidence-based medicine—also helps to support oncologists who require large staffs to treat these complex patients and provides the practice with enhanced reimbursement to offset the lower fees they receive when prescribing less expensive drugs,” said Jennifer Malin, MD, in a news release from WellPoint. She is the insurer’s oncology medical director.

Providers will continue to be reimbursed for visits and cancer drugs according to the terms of the member’s health plan regardless of whether a treatment is on pathway, however, only pathway regimens are eligible for enhanced reimbursement.

“Chemotherapy makes up 25 percent of the costs to treat health plan members who have cancer, and this percentage is growing faster than any other part of care,” said Doug Wenners in a news release. The vice president for provider engagement and contracting said that, “It’s clear that our approach to cancer therapy is the answer in making a positive impact on quality and in slowing the rate of these increases to keep premiums as affordable as possible.”


WellPoint’s New Quality Initiative Aims to Improve Cancer Outcomes, Promote Access to Evidence-Based and Cost-Effective Care. http://ir.wellpoint.com/phoenix.zhtml?c=130104&p=irol-newsArticle

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