Adhering to established treatment guidelines is an important component of ensuring optimum care for patients with cancer. It is also becoming increasingly important as a way for physicians to ensure that they receive the optimum level of reimbursement for the services they provide. To help physicians manage the complexities of meeting benchmarks and reporting their compliance to payers, US Oncology recently announced Payer Quality Services. This program will give physicians in the United Network of US Oncology access to a collection of resources and tools, including the Level I Pathways Program. These evidence-based guidelines and operating procedures for treating the 14 most commonly diagnosed cancers are available electronically through iKnowMed, US Oncology’s Web-based electronic health records (EHR) system, and the Innovent Oncology Portal. Participating oncologists will have access to this clinical quality benchmarking program and to patient and referring physician loyalty survey programs. They can also request on-site or remote support with payer negotiations.
Bruce Broussard, chairman and CEO of US Oncology, said in a press release, “Our new Payer Quality Services offering brings to bear the managed care and pay-for-performance expertise of US Oncology to help community oncology practices effectively collaborate with payers to align the interests of the patient, payer, and physician.”
Broussard said the US Oncology network has amassed years of experience and derived insight from participation in pay-for-performance contractual relationships involving nearly 20% of the network’s physicians and 6 million covered lives in the country, making it uniquely qualified to launch this initiative.
The Need for a New System
A growing number of insurers are instituting pay-for-performance initiatives in the United States. Michael Kolodziej, MD, is a physician at New York Oncology Hematology, Albany Medical Center, a US Oncology affiliate. Kolodziej was one of several physicians involved in the program’s development.
“Pay-for-performance is here to stay,” said Kolodziej. He noted that many current programs have not clearly demonstrated that they can control costs without compromising the quality of care, and they rely on benchmarks that have not been validated as indicators of improved patient outcomes.
“We needed a system that would measurably improve the quality of care by providers, and that would help to lower costs by addressing the key factors driving up healthcare costs—mainly treatment variability and unscheduled hospitalizations and emergency room visits,” Kolodziej explained. “US Oncology’s Level I Pathways is one of the few evidence-based guideline programs that considers cost, after ensuring high-quality patient care by adhering to the best available evidence.”
Terry Kopp, vice president of Innovent Oncology, a wholly owned subsidiary of US Oncology, agreed that the new system is greatly needed. “The current environment where physicians are reimbursed largely based on drug utilization is not sustainable,” he said. Innovent Oncology manages the Level I Pathways program and provides proactive patient support and advance care planning to address key drivers in quality and cost of cancer care.
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