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

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.