NOW Initiative: Payer & Provider Collaborations in Oncology Benefits Management

Aileen M. Soper, BA; C. E. (Gene) Reeder, RPh, PhD; Loreen M. Brown, MSW; Ana Stojanovska, BS; and Barbara J. Lennert, RN, BSN, MAOM
Published: Friday, May 14, 2010
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Payers recognize the need to expand benefits management for oncology but struggle to find effective solutions amid the complexity of available therapies and skepticism from oncologists, who are facing their own set of economic pressures. The National Oncology Working Group (NOW) Initiative is trying to change the sometimes adversarial relationship between payers and oncologists through a collaborative model. The group, which is supported by pharmaceutical manufacturer sanofi-aventis, is developing patient-centered strategies for successful and sustainable oncology benefits management. The focus includes finding consensus between payers and providers and devising solutions for oncology management such as decreasing variability of cancer care and improving end-of-life care for patients with terminal illness. NOW is designing tools that will be tested in small-scale regional demonstration projects, which NOW participants anticipate will set an example for successful oncology benefits management that can be replicated and expanded.

Pharmaceutical manufacturer sanofi-aventis began planning the NOW Initiative in 2007, when commercial payers started to manage oncology therapies more actively, yet lacked a forum to encourage oncologist participation. During a 2009 interview with the director of oncology account management teams at sanofi-aventis, Joe Baffone said, “There had not been a platform for those discussions to happen. We needed to figure out how we could facilitate this.”

According to Chris Leidli, senior director of oncology marketing at sanofi-aventis, the company’s support for the NOW Initiative complements its commitment to payer education. “We would like to see coverage and policy decisions in effect that ensure patients receive full access to all the available treatment options that are appropriate,” Leidli said.

The effort began with plans for advisory boards, market research, and opportunities for increased interaction between payers and oncologists. sanofi-aventis partnered with AmerisourceBergen Specialty Group to recruit the NOW advisors and to facilitate meetings. Xcenda’s Managed Care Network,1 a panel of pharmacy and medical directors representing more than 150 million covered lives, and the International Oncology Network, an oncology drug group purchasing organization, are part of the AmerisourceBergen Specialty Group family of companies. NOW’s payer advisors were recruited from the Managed Care Network, and the physician advisors were recruited through the International Oncology Network.

In addition to being active in the Managed Care Network, the NOW payer advisors are executivelevel decision makers at national or regional managed care organizations. NOW’s provider representatives are active in the International Oncology Network’s large provider practice group and include practicing oncologists and oncology practice administrators. Advisors were chosen for their oncology expertise, willingness to collaborate with other stakeholders, and understanding of evidence-based clinical pathways. They were also selected based on their willingness to engage in multiple live meetings, Web-based surveys, and teleconferences.

In mid-2008, NOW advisors completed Web-based surveys tailored specifically to providers and payers that revealed shared concerns and opportunities for collaboration. For example, 95% of providers (n = 50) and 64% of payers (n = 50) agreed that guidelines and pathways had a “somewhat significant” or “very significant” role in their organizations. In addition, more than 80% of payers and providers surveyed agreed or strongly agreed that their groups could work together on evidence-based and cost-effective quality-of-care improvement efforts.

In June 2008, payers and providers attended separate meetings to further explore issues identified during the surveys. Those sessions were followed by a payer—provider summit in November 2008.

Once the tools that NOW is designing are ready, the group will explore the feasibility of regional demonstration projects that would call for payers and providers to identify metrics to evaluate and reward quality improvements in cancer care. Exact details surrounding the demonstration projects, including how process measures will be developed and how sites will be chosen, are in the conceptual stage. However, NOW’s vision includes selecting metrics from widely accepted evidence-based clinical guidelines for oncology care such as those developed by the National Comprehensive Cancer Network or the American Society of Clinical Oncology. Oncology practices participating in the demonstration projects would report on quality measurement data, primarily using electronic tools or processes. These data would be used to generate reports to help oncology practices and managed care plans evaluate the providers’ progress. Practices that meet established benchmarks might receive incentive payments. The provider data would also be combined with the payer’s administrative claims data to give a full picture of the oncology management strategies and outcomes. “We are trying to be part of the solution by changing the paradigm of how oncology is managed and reimbursed,” said Ken Trader, AmerisourceBergen Specialty Group’s vice president of strategic accounts for managed care.

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