Cost Reduction, Quality Improvement, and Reimbursement Increases

In August 2008, CareFirst BlueCross BlueShield (CFBCBS), in partnership with Cardinal Health Specialty Solutions, launched the first cancer clinical pathways program in the United States. Oncology clinical pathways are evidence-based treatment regimens for the treatment of breast, lung, and colon cancers.

With the cost of cancer care projected to reach $170 billion by 2020, the pathways were developed to achieve 3 main goals: (1) reduce the expected increase in cost; (2) maintain the current quality of care for patients with cancer; and (3) preserve fair compensation for physicians.

Researchers recently conducted a study to obtain third-party validation of savings generated by the pathways program that had been observed previously and reported at the American Society of Clinical Oncology (ASCO) 2010 Annual Meeting. Results of the current study were reported during a poster session at the ASCO 2013 Annual Meeting. The poster was titled Validation of Observed Savings from an Oncology Clinical Pathways Program.

The researchers, led by Jeffrey A. Scott, utilized data from CFBCBS claims data from January 2007 through December 2010 to identify patients with breast, colon, or lung cancer who were treated by physicians participating in the clinical pathways program.
A control group treated by non-institutional physicians in a similar geographic area was retrospectively identified utilizing Truven Health’s MarketScan^® database. The 2 groups were further balanced using propensity score weighting to align primary diagnosis and demographics.

The primary study outcome measure was the sum of allowed costs for 270 days after a patient’s first chemotherapy treatment. A secondary outcome was the probability of an inpatient admission over the same time period.

The CFBCBS cohort included 2424 patients, compared with 1490 patients in the aligned control group. The treatment coefficient from the linear model for the primary outcome was -0.16 with a z-value of -3, demonstrating that CareFirst reduced its overall costs for treating breast, lung, and colon cancers by 15%. The savings were generated primarily through a 7% decline in visits to the emergency department, shorter length of stay in the hospital, increased use of generic medication, and increased use of chemotherapy.

The treatment coefficient from the logistic model for the secondary outcome of reduction of inpatient hospital admissions was -0.29 with a z-value of -2.5, which was a 7% reduction in hospital admissions (from 50% to 43%).

The researchers noted that while there was also reduction in the overall drug spend, the reimbursement to physicians increased for both branded and generic drugs. In addition, physicians received higher reimbursement overall.

In conclusion, the researchers stated, “We conclude that the CFBCBS pathways program saved upwards of 15% on cancer-related claims costs with a 7% reduction in the probability of an inpatient admission. These findings are consistent with those previously presented and peer reviewed.”

The researchers added that “payer-physician collaboration was a significant factor behind the success of this clinical pathways program,” according to a press release from Cardinal Health.