Evaluation of a regional payer-based pay-for-quality (P4Q)oncology program showed thatPathways programs can greatly reduce the cost of cancer care by slowingthe growth rate of both drug andnondrug expenses.
Although oncology clinical Pathways are common in current practice,there has been little evaluation of howcosts can be reduced when Pathwaysare enacted. This study evaluated thepotential cost-savings of a payer-basedP4Q program employing clinicalpathways, said Jeffrey A. Scott,MD, and colleagues from P4 Healthcare in Ellicott City and CareFirstBlueCross BlueShield, Baltimore, MD.
P4 Healthcare is a privately heldhealthcare company that helps oncologypractices increase efficiency andenhance the quality of patient care.
Dr Scott described a P4Q programenacted in 3 northeastern states onAugust 1, 2008, that had 57 participatingpractices (176 physicians; 10,432patients). Participating practices werecompared with 43 nonparticipatingpractices (194 physicians; 4137patients). The Pathways, developedby a 15-oncologist steering committee,consisted of physician-generatedtreatments (breast, lung, and colorectalcancers) and supportive care pathways(colony-stimulating factors, erythropoiesis-stimulating agents, andantiemetics) based on medical literatureand national guidelines.
Participants received feedbackregarding compliance. Fee schedulesin year 1 of the program were adjustedin year 2 contingent on compliance inyear 1. Savings analysis used the differencebetween the participating andnonparticipating practice growth ratesfrom the year before the program (pre)to year 1 to estimate yearly savings forthe participating practices.
The study found that 96% of theparticipating practices were able tomeet the 65% treatment compliancethreshold and the 80% supportivecare compliance threshold. Acrossall participating practices, 86% and95% of patients complied with treatmentand supportive care pathways,respectively.
The study found the pre-year 1 toyear-1 growth rate in cost was 7.7%for antineoplastic drugs, –3.0% forsupportive care drugs, and 2.8% fornondrug services in the participatingpractices. In contrast, costs in the nonparticipatingpractices were 15.4%,2.4%, and 19.0%, respectively, DrScott reported.
Estimated savings between Pathways participants and nonparticipatingcenters (Table) were calculatedfor antineoplastic drugs ($6,766,500),supportive care drugs ($1,427,108),nondrug services ($4,039,359), andtotal costs ($12,232,967). When thecosts of the year-1 fee scheduleincrease for participating practiceswere factored out, the total savingswere estimated at $8,585,149.
“Our further evaluations willexplore the indications of how thesecosts were reduced, for instance, bydrug selection, and consider clinicaloutcomes and compliance in relationto cost-savings,” Dr Scott said. “Although the majority of the estimatedcost-savings were drug-related (77%),the amount of savings due to nondrugservices was substantial,” he added.
