“Oncology is unique, but it’s less unique than it used to be.” So said Daniel Mullins, a healthcare economist at the University of Maryland School of Pharmacy, during an opening workshop held April 18 at the Academy of Managed Care Pharmacy’s annual event in San Francisco.
Such language is an overt acknowledgement that soaring oncology costs are a collective problem for US payers, many of whom are experimenting with evidence-based initiatives like cancer pathways or novel reimbursement plans for providers (or sometimes both). But before they can leverage pathways and bundled care, payers must open their doors to community oncologists and convince them to collaborate.
“We’ve got to engage providers and come up with consensus,” admitted Dr. John Cruickshank, chief medical officer of the New Mexico-based payer Lovelace Health Plan at the AMCP meeting.
That’s music to the ears of Dr. Barry Brooks, a medical oncologist with Texas Oncology, a community-based practice affiliated with Innovent’s US Oncology. In a recent 15 minute podcast with Real Endpoints, he offers a provider’s perspective on the engagement issue, as well as simple solutions.
Brooks is a big fan of cancer pathways and understands why payers believe the concept is a powerful tool to lower oncology costs. But he predicts providers would embrace the concept in greater numbers if payers would agree to two simple things. First, payers should agree to waive prior authorization requirements, which eat up considerable time and administrative resources and are perceived by physicians as a barrier to care. Second, payers should also relinquish the right to retrospective reviews of care plans (outside of ensuring an evidence-based protocol is actually being used).
Nor does Brooks see a need right now to clutter the pathway conversation with financial incentives that aim to pull physicians in via bundled reimbursement models that are hard to understand (and even harder to calculate). Instead, according to Brooks physicians could be asked near-term to embrace clinical pathways in “a take it or leave it” fashion. But, he says, for physicians who take it, “it’s a lot easier” because the administrative hassles associated with prior authorizations are no more.
In sum, eliminating prior authorization is the carrot to higher quality (and potentially lower cost) cancer care. Better yet, no sticks that might put a payer on the front page of the newspaper are required.
For more of Brook’s perspective on cancer pathways and potential barriers to provider adoption, click on this link.
Key image courtesy of flickrer Uriel Akaria via creative commons.