Value Propositions

June 2014, Vol 5, No 5 - Value Propositions


WellPoint Introduces Value-Based Insurance, Will Pay Oncologists $350/Month per Patient on Pathway
Using value-based insurance to rein in the ever-rising costs of cancer care, WellPoint will begin to pay oncologists $350 monthly this summer for every patient who is being managed according to the company’s clinical pathways. The program will launch in 6 states and will expand to the entire country by mid-2015, starting with breast, lung, or colorectal cancer, and then applying to other cancers. Other health plans have introduced pathways in oncology as a means to control costs using different payment methods, but this introduces a new approach to reimbursement in oncology.

Brian J. Bolwell, MD, Chairman of Cleveland Clinic’s Taussig Cancer Institute, said the clinic will participate in the program “where it makes sense.” He noted that although WellPoint’s clinical recommendations were reasonable, Cleveland Clinic is developing its own treatment pathways, which may not coincide with every plan’s pathways. “We generally don’t like to practice by insurance company, we practice by patient,” Dr Bolwell said. Indeed, other providers may also find this too intrusive, but the $350 added value for providers will likely go a long way toward acceptance of this approach.

“Oncologist reimbursement at the moment is a broken system,” suggested Richard Schilsky, MD, Chief Medical Officer of the American Society of Clinical Oncology. He noted that WellPoint’s plan provides “many of the important elements you’d like to see” in such a pathways program, but added that although this type of program can make sure that all patients get the same treatment, “precision medicine wants to drive toward everyone getting unique treatment.” However, WellPoint’s pathways may take precision medicine into account after all.

If fact, the company believes its program will be in line with new developments in personalized medicine and genetic innovation. It notes that its pathways will apply to only 80% to 90% of patients, and that oncologists will not have any penalties for using treatments that are not on pathway. “There are always going to be unique clinical situations,” said Jennifer Malin, MD, PhD, Medical Director for Oncology Care Management at WellPoint. She said the treatment guidelines will be reviewed at least every 3 months and updated regularly, as needed.

The company estimates that its new program will save approximately 3% or 4% of its cost of cancer treatments, which is approximately $5.4 billion annually. The Wall Street Journal; May 27, 2014


New Approach May Overcome Resistance to Erlotinib Therapy in Lung Cancer
Among patients with lung cancer, as many as 40% do not respond to a targeted therapy with erlotinib (Tarceva), an EGFR inhibitor used for the treatment of patients with non–small-cell lung cancer (NSCLC). The cause for this resistance and how to overcome it have not been known until now.

A new study demonstrates that this resistance is caused by overexpression of the growth protein Cripto-1, which makes lung cancer cells resistant to erlotinib.

Laboratory experiments showed that blocking Cripto-1 signaling transduction overcame the resistance to erlotinib and restored sensitivity to the drug. They used a Src inhibitor, because Cripto-1 activates the oncogenic tyrosine-protein kinase Src. And although the drug used in the study is no longer available, at least 1 other Src inhibitor, dasatinib (Sprycel), has been approved by the US Food and Drug Administration for the treatment of patients with chronic myelogenous leukemia.

“This is a welcome finding because Cripto-1 belongs to a family of proteins that can be targeted by drugs that have already been developed,” said the lead investigator Giuseppe Giaccone, MD, PhD, Associate Director for Clinical Research, Georgetown Lombardi Comprehensive Cancer Center. Dr Giaccone said that the center is about to be launching a new clinical trial to see if these findings can be duplicated in human patients. The trial will test the combination of erlotinib plus AZD042, an investigational Src inhibitor, in patients with NSCLC. The study will include patients with EGFR mutation, because these patients have been shown to be most sensitive to erlotinib.

“There has been very little investigation when a person never responds to an EGFR inhibitor—most research has been done on acquired resistance that occurs after the drug has shown some benefit,” Dr Giaccone said. “Most patients using erlotinib exhibit either intrinsic or acquired resistance, so we frankly don’t cure anyone with the drug, although we can extend lifespan.”

Dr Giaccone observed, “If we can understand what is limiting the activity of the drug up front, I believe treatment of patients can be vastly improved.” The study was supported by the National Cancer Institute. Georgetown University Medical Center; June 9, 2014