New Tools Arriving to Measure and Manage Chemotherapy Care
Baltimore, MD—A long-held business truism is that “if you can’t measure it, you can’t manage it.” The application of this belief to the oncology setting was demonstrated at a session of the Association of Community Cancer Centers’ (ACCC) 36th Annual National Meeting. Kimberly Bergstrom, PharmD, chief clinical officer for McKesson Specialty Care Solutions, told attendees of the growing importance of developing and using standardized chemotherapy treatment regimens, and of the tools that can benchmark performance and foster compliance with treatment guidelines.
Public and private payers are moving to control exploding healthcare costs, Dr Bergstrom told attendees, and because increased cost control was inevitable, it is in providers’ interest to get a seat at the table.
“It is an important topic, because this is one of those things, if we don’t get a handle on it, it’s going to happen to us,” she said. “People and groups and organizations are going to start dictating how we provide cancer care, and we can’t let that happen.”
Cost Increases, Cost Management
According to Dr Bergstrom, the last decade has seen a shift by payers in their approach to managing spending for oncology drugs. Up until the early 2000, there was little in the way of medical policy guidance and pre-authorization. In the early to middle part of that decade, preauthorization and guidance was applied to select high-value and high-risk products. From the mid-2000s on, medical policy has increasingly been based on care guidelines and pathway, and this evolution has led to increasingly complex administrative requirements and data needs on the parts of both payers and providers.
Health plans are taking a number of long- and short-term approaches to managing costs, she said. The plans “have a huge interest in reducing your drug margin to save them money,” said Dr Bergstrom. “They want to move [physicians] away from their dependence on the drug margin and move to more service-based fees. They want to separate the oncology income from drug sales.”
But many payers, said Dr Bergstrom, are currently reducing costs on their own terms, and cutting into providers’ bottom lines.
“This really provides us with a great dilemma,” she said. “Decreased revenue, increased administrative burden, and costs. Payers are managing specialized care aggressively. And they’re using 2 key tools that they know best: they’re reducing your fee schedules and they’re requiring prior authorization.”
But reduced costs don’t have to mean reduced care. According to Dr Bergstrom, cost control and standardization of effective treatment regimens should go hand in hand.
“They are creating payment policies that actually reward clinical performance,” she said. “A lot of that has to do with the focus on standardized treatment guidelines and rewards for achieving certain clinical measures.”
From Onerous to Opportunity
Dr Bergstrom argued that increased payer scrutiny creates an opportunity for caregivers to examine practice efficiency, to present community-based oncology as a cost-efficient means of care delivery, and to explore a wider use of data-based performance. Standardized chemotherapy regimens increase practice efficiency, reduce errors, simplify billing, and make it easier to measure outcomes of care, Dr Bergstrom suggested. And from the payer’s perspective, improved care consistency and predictability of costs is appealing, as is the ability to prove quality and value to plan sponsors and patients.
There are a number of free clinical tools that can help with benchmarking and standardization (Table). In addition, limiting the number of chemotherapy regimens via an electronic medical record and standardizing prechemotherapy medications, supportive care drugs, and antineoplastic dosing are helpful means of standardizing care, Dr Bergstrom suggested.
Other analytical tools provide the ability to track and manage costs, reimbursement, and profitability. With today’s narrow financial margins, Dr Bergstrom noted, making physicians aware that a particular chemotherapy regimen is “underwater” (ie, more expensive than the reimbursement given for it) in real time is essential. She recommended that practices regularly check their standardized regimens against the quarterly changed Medicare fee schedule to ensure continued profitability. Some of these chemotherapy management tools include ION Protocol Analyzer (www.iononline.com), McKesson’s Onmark Regimen Profiler (www.onmarkservices.com), and P4 PBIS eobONE (www.p4healthcare.com).
Having a clinical and cost conversation is essential in today’s environment, Dr Bergstrom emphasized. “If you can get your physicians together and talk about how to focus your approach to care for certain diagnoses, and really narrow the choices of regimen, you will improve quality across the team,” she said. “Because all of a sudden instead of every physician doing a slightly different version of CHOP or FOLFOX…everyone’s going to be singing from the same songbook. The nurses aren’t confused. Everyone is standardized. Your billers know what to bill: it’s the same thing over and over again.”
“Payers need consistency of care,” concluded Dr Bergstrom. “If they can predict what the costs of cancer care are, they will be able to set their premiums better.”