UnitedHealthcare Leads Bundled Payments for Cancer in Costs-Saving Pilot
Healthcare costs are consistently on the rise within the United States. In fact, economists Richard Young and Jennifer DeVoe predict that in less than three years time, it will require the average United States household 50 percent of their income to pay the costs of out-of-pocket expenses and the health insurance premium for a family.
Cancer treatments are a primary contributing factor for these rising costs, accounting for 11 percent of UnitedHealthcare’s commercial health plan budget. A recent pilot program created by the group in an attempt to lower these costs, however, seems promising.
In a three-year alternative reimbursement pilot with five medical oncology practices, UnitedHealthcare said it found significant cost savings without negatively impacting outcomes.
In a study published by the Journal of Oncology Practice, UnitedHealthcare changed four elements of the previous fee-for-service contract relationship, achieving cost savings by paying oncologists upfront for an entire treatment regimen, regardless of the medication used. A 34 percent reduction of the predicted total medical cost was achieved, the study noted.
Out of 1,024 patients enrolled in the program, 810 patients with breast, colon and lung cancers were used in the analysis. The program based episode-of-care payments on expected costs for standard six- to 12-month treatment regimens, with chemotherapy medications reimbursed at the average sales price as a proxy for the acquisition of the drug.
In patients with cancer recurrence, bundled payments were renewed every four months, allowing oncologists to determine if therapy was no longer effective for a patient. Payments were also continued for patients enrolled in hospice or no longer receiving chemotherapy.
Physicians from the five oncology groups met twice during the study period to review and analyze more than 60 measures of cost, quality and use. During the meetings, group leaders discussed potential solutions for variation and later shared the data with practice partners.
According to Lee Newcomer, MD, senior vice president of oncology at UnitedHealthcare and a study co-author, when new evidence requires changing a chemotherapy regimen to a more expensive drug, neither the episode payment nor physician profit is increased. The physician is protected, however, from financial loss due to being reimbursed the drug’s average sales price, equivalent to its acquisition cost.
Early identification of cancer within the patients was essential to ensure the correct treatment regimen and explain the adjusted claim payments. The program yielded significant savings for the treatment of patients with cancer without any measurable effect on quality outcomes or toxicity, the study noted.
While there wasn’t sufficient analysis for survival outcomes, the study authors argued that the finding “challenges the assumption that any reduction of resources results in worse outcomes for cancer.”
According to Newcomer, “early results from UnitedHealthcare’s pilot programs show opportunities for improved care and cost reduction.”
The opportunity for physicians to compare multiple regimens with similar response rates by using the pilot’s data to select the most cost-effective therapies is a game changer. The best practices are also not limited to drugs alone, as radiology, radiation therapy, lab testing and other services can also be evaluated.
“Any payment system needs a broad consensus about the maximum amount of money society will pay for an additional month of life,” wrote Newcomer. “The task is daunting, but the time has come to experiment with new models.”
About 11 percent of UnitedHealthcare’s commercial health plan spending is devoted to cancer therapy with the company expecting to increase that number alongside national trends. According to the National Cancer Institute, annual national cancer therapy costs stood at $124.6 billion in 2010 and could reach as high as $207 billion by the year 2020.
To read the study, visit the Journal of Oncology Practice.
Dexcom: changing the lives of people with type 1 diabetes
It is estimated that 9.3% of adults around the world are living with type 1 diabetes, which amounts to a total of 463 million people. A further 1.1 million children and adolescents under the age of 20 are living with the condition.
Unlike the more prevalent type 2 diabetes, where the body still produces insulin and symptoms develop slowly, people with type 1 diabetes need regular insulin injections or pumps, and must monitor their sugar levels frequently.
In recent years a number of remote glucose monitoring systems have become available that patients can use at home. These work with a sensor, usually placed under the skin, that measures glucose levels every few minutes. This information is then transmitted wirelessly to a device like a smartphone or tablet, which can then be shared with their clinician.
British actress Nina Wadia's son Aidan, 14, has type 1 diabetes, and has been managing his condition using Dexcom, a glucose monitoring system used by patients all over the world. Here Wadia explains how Dexcom has improved their lives.
As a parent of someone with type 1 diabetes, what is your day-to-day life like?
Being able to take a breath, think and pivot constantly without getting frustrated becomes an essential mindset because sometimes it feels like each day is determined to be different from the day before. Whatever worked yesterday is going to misfire today.
Which areas of yours and Aidan’s life are most impacted by diabetes?
The one thing that you have to fight hard to reclaim is spontaneity, especially when it comes to food and exercise. It’s only when this is taken do you realise how essential each one is. You can be flexible and there are no real limits, but only in the sense that a great athlete can be flexible without limits because they’ve trained super hard to be that way. So we’ve all had to become athletes when it comes to being spontaneous.
How has Dexcom helped you and Aidan?
Dexcom has brought future science fiction to real life today. The continuous glucose monitoring system is tiny, sits discreetly on his body and gives him a ten-day breather between sensor changes, so it's goodbye finger-pricking seven times daily.
Dexcom is totally active at a grass roots level and for Diabetes Awareness has pledged to donate £2,000 if #DexcomDiabetesStories and/or #DexcomWarriorStories is shared 200 times! I’ll be sharing more on social media and would love to hear how other families are winning their fights.
Maybe most importantly Dexcom is trying to introduce a reimbursement programme for type 1 diabetes patients which will give greater access to modern, life changing hi-tech. I want to spread the word on the importance of accessing it through this campaign.
If you compared your life today with how it was before Aidan was using Dexcom, what has changed?
It's always working, which lets him take his mind off diabetes for longer stretches. It also lets me get off his back. We both receive alerts so I no longer have to pester him by asking him what his number is, and especially importantly, I don’t have to wake him at night to prick his finger if I’m worried. Dexcom gave us back our sleep!