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Highmark Cancer Collaborative reports 83 percent adherence to evidence-based treatment protocols; extends episode-of-care payment models to prostate and lung cancers

Highmark Inc.

Expanded access to early phase clinical trials for patients in western Pennsylvania

PITTSBURGH, Pa. (June 7, 2017) — Highmark Cancer Collaborative today announced that in its first year, participating medical oncologists and radiation oncologists achieved industry leading results that positively impact Highmark members. This success included 83 percent adherence with clinical pathways (evidence-based treatment guidelines promulgated by leading national cancer experts, centers, and specialty societies) and payment models that incent value-based care over the volume of procedures performed. Published studies indicate 35 percent costs savings are associated with pathways concordance.1

In addition, through collaboration with Johns Hopkins Kimmel Cancer Center, Highmark Cancer Collaborative has facilitated expanded access to innovative clinical trials available to patients in western Pennsylvania. The Collaborative also introduced second-opinion consults for rare and complex cancers with leading cancer researchers and increased the use of appropriate molecular testing to provide actionable data for use in optimizing treatment and providing a safer, more patient-friendly experience of care.

Medical pathways guide treatment for 23 different types of cancer

The knowledge explosion in cancer research is accelerating at such a pace that an oncologist would need to read 17 articles per waking hour 16 hours a day 365 days a year in order to keep current.2 "Obviously this is untenable," said David Parda, MD, chair of the Allegheny Health Network (AHN) Cancer Institute. "Clinical pathways use data analytics to distill up-to-the-minute research and tailor its application to specific patients in real-time at the point of care. As such, pathways fit seamlessly into our work flow which is why we find them valuable."

Highmark provides clinical pathways software free of charge to oncologists participating in the Cancer Collaborative. Pathways can be integrated with electronic medical records and with genetic testing, which indicates how well a patient is likely to respond to a specific targeted treatment, immune therapy, or chemotherapy agent. They can even incorporate cost data so the oncologist and patient together can evaluate the costs of various treatment options.

"The high cost of cancer treatment is of great concern to our members," said Christopher Burnett, director of Strategic Clinical Solutions at Highmark. "One third of cancer patients are bankrupted by their care.3 Yet without specific and comparative cost information, oncologists cannot fully respond to patients' questions and fears about cost, or factor in the out-of-pocket impact to their patients when weighing equally effective treatment options."

During its inaugural year, 29 physician practices participated in the Highmark Cancer Collaborative pathways program. Together they made over 2,000 treatment decisions using these decision-support tools, demonstrating how quickly best practices can be adopted. Based on this success, Highmark Cancer Collaborative is expanding its clinical pathways program to include guidelines on five additional cancers — myelodysplatic syndromes, kidney, bladder, esophageal, and gastric cancers. These five cancers were selected because data indicates their inclusion would greatly impact additional Highmark members. Highmark Cancer Collaborative now offers clinical pathways for 23 different types of cancer, covering over 96 percent of cancers impacting Highmark members.

Episode of care payment models extend to prostate and lung cancers

Financial incentives in health care have long been misaligned, rewarding volume of procedures performed over value of care received. Highmark Cancer Collaborative addresses this issue with a physician-friendly episode-of-care reimbursement model. Physicians receive half of the agreed-upon fee when treatment begins and the remainder at its conclusion, providing a more predictable income stream. Highmark also eliminates preauthorization requirements so there is no delay in treatment while authorizations are approved.

In 2016, Highmark Cancer Collaborative applied an episode-of-care model to radiation treatment for breast cancer. Radiation oncologists were paid for a complete course of radiation instead of piecemeal for each radiation session. This removed financial disincentives for selecting an equally effective but shorter course of treatment. Through this initiative, Highmark Cancer Collaborative increased utilization of a three-week course of radiation instead of the more common six-week course. Published studies show little additional benefit to six weeks over three, with clear benefit to the women of using the least amount of radiation necessary to achieve the clinical goal. Based on this success, Highmark Cancer Collaborative is expanding its episode of care model to prostate cancer with lung cancer soon to follow.

About the Highmark Cancer Collaborative

The Highmark Cancer Collaborative was founded in March 2016 to address the crisis in cancer care by creating replicable models for the creation and dissemination of best practices in cancer care. Fragmented and unwarranted variations in care contribute to the skyrocketing cost of cancer treatment, potentially putting treatment beyond the financial reach of many individuals. Costs are expected to reach $207 billion by 2020.4 Chemotherapy drug prices are already rising at an annual rate of 17 percent.5 The Highmark Cancer Collaborative addresses this crisis by bringing together insurers, providers, and leading cancer researchers to collaborate on an integrated portfolio of clinical programs, clinical pathways, and reimbursement models that put members’ health, safety, and financial well-being at the center of value-based care. Founding partners include Highmark, Allegheny Health Network (AHN) Cancer Institute, and Johns Hopkins Kimmel Cancer Center.

About Highmark Inc.

Highmark Inc. and its health insurance subsidies and affiliates collectively are among the ten largest health insurers in the United States and comprise the fourth-largest Blue Cross and Blue Shield-affiliated organization. Highmark Inc. and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5 million members and hundreds of thousands of additional members through the BlueCard® program. Its diversified businesses serve group customer and individual needs across the United States through dental insurance, vision care and other related businesses. Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.

About Allegheny Health Network Cancer Institute

Allegheny Health Network, part of Highmark Health, is a western Pennsylvania-based integrated healthcare system that serves patients from across a five-state region that includes Pennsylvania, Ohio, West Virginia, Maryland and New York. The Network's Cancer Institute provides advanced, multi-disciplinary care for malignant diseases, including access to state-of-the-art technologies and new therapies being explored in clinical cancer trials. The Institute's programs reach patients at more than 50 clinic locations throughout western PA and employ more than 150 oncologists. The Institute is home to one of Pennsylvania's largest bone marrow and cell transplant programs and the largest radiation oncology program in the country that is dually accredited by both the American Society for Radiation Oncology and the American College of Radiology. The Institute also serves as the leadership base for the National Cancer Institute-funded National Adjuvant Breast and Bowel Project (NSABP) and collaborates with Johns Hopkins Kimmel Cancer Center to advance clinical expertise, medical education and cancer research programs.

1 National study published in the Journal of Oncology Practice found that patients following evidence-based clinical pathways for oncology treatments saw 35 percent lower costs versus patients receiving traditional treatment approaches.
2 "Advances in Website Information Resources to Aid in Clinical Practice," presented at the American Society of Clinical Oncology Annual Congress, Chicago, Illinois, June 2015.
3 Fred Hutchinson Cancer Research Center, Health Affairs, June 2013
4 The National Cancer Institute estimates costs for cancer therapy to reach $207 billion in 2020.
5 Evaluate Pharma, Manufacturer's Prescribing Information Pamphlet.

For more information, contact:
Wendy Morphew
Highmark Inc.
412-544-3616
917-697-1782 (mobile)
Wendy.Morphew@Highmarkhealth.org