US Oncology and Milliman Release Report on Better Management Opportunities...
US Oncology and Milliman Release Report
on Better Management Opportunities for Cancer Patients
Study Reveals Unexplained Variation in Utilization and Costs
for Cancer Patients Receiving Chemotherapy
The Woodlands, Texas (June 2, 2010) —Over the course of a year, a cancer patient receiving chemotherapy incurs, on average, approximately $111,000 in costs, which is almost four times the cost of a cancer patient not receiving chemotherapy, three times the cost of a coronary artery disease patient, and six times the cost of a diabetes patient. These statistics and other medical utilization and costs of cancer patients receiving chemotherapy are quantified in a new study released today by Innovent Oncology, a subsidiary of US Oncology, and performed by Kate Fitch and colleagues at Milliman, Inc., a premier global actuarial consulting firm. The study also identifies variation in several utilization and cost measures indicating opportunities for better quality and cost management.
Innovent Oncology commissioned Milliman’s Fitch and co-authors in New York to evaluate 10 of the most common cancer types where chemotherapy is a key treatment modality. The utilization and cost metrics examined include: chemotherapy-related hospitalizations; chemotherapy-related emergency room visits; chemotherapy costs; and end-of-life care including hospice enrollment, death in a hospital and chemotherapy administration within 2 to 4 weeks of dying.
The study used a nationally representative claims database of 14 million commercially insured lives. The 10 cancers identified in the study account for 65% of cancer patients in a commercial population and approximately 25% of these cancer patients received chemotherapy treatment during the observation year. The members receiving chemotherapy and having one of the 10 cancers make up about 0.11% of commercial members, but account for about 4% of overall healthcare costs.
Regional variation is identified with respect to the first three metrics listed above. Chemotherapy-related inpatient admissions and emergency room visits show a two-to-three fold regional difference in rates and chemotherapy drug costs range from $17,000 to $27,000. These regional differences suggest opportunities for health plans and plan sponsors to improve quality, thereby reducing cost and utilization.
Proactive end-of-life care provides patients with higher quality care and both patients and payers with additional quality and cost savings opportunities. For chemotherapy patients with the 10 cancers that were identified as dying in an inpatient setting, 24% received chemotherapy within 14 days of dying and 51% received chemotherapy within 30 days of dying.
“This is a comprehensive commercial payer view of cancer patients receiving chemotherapy and various cost drivers,” says Kate Fitch, RN, MEd, Principal and Healthcare Management Consultant with Milliman. “We are very pleased that Innovent Oncology is publishing this report, especially because there is a growing concern over variation and waste in cancer care."
While the reasons for variation in chemotherapy prescribing patterns have not been well documented, the benefits of following treatment guidelines, or evidence-based medicine, are well-established including improved outcomes and reduced cost. While some health plans are moving towards managing chemotherapy utilization, few offer incentives to oncologists to show adherence to these treatment guidelines in order to receive reimbursement.
“This study suggests that there are opportunities for better management of chemotherapy patients. I share the belief of many that evidence-based medicine provides the roadmap for physicians and payers to follow,” says Roy Beveridge, M.D., medical director for US Oncology. “Physicians affiliated with Innovent Oncology apply evidence-based medicine, proactive patient management and support, and advance care planning to patient care. This increases the quality and consistency of care received by patients, and aligns incentives to produce better patient outcomes while reducing the overall cost of care.”
Level I Pathways are evidence-based medicine guidelines developed by physician-led committees of disease experts from US Oncology through a consensus building process. Physicians have developed Level I Pathways for the 14 most commonly diagnosed cancers. Physicians choose which treatment is best based on the patient’s needs. Each Pathway is updated regularly as new science reveals better, more appropriate care. These Level I Pathways are available to physicians through affiliation in the United Network of US Oncology or directly through participation in payer sponsored programs through Innovent Oncology.
About US Oncology
US Oncology, Inc. is the nation’s leading integrated oncology company. By uniting the largest community-based cancer treatment and research network in America, US Oncology expands patient access to high-quality, advanced care and advances the science of cancer care. Headquartered in The Woodlands, Texas, US Oncology is affiliated with more than 1,000 community-based oncologists, and works with patients, payers, and the medical industry across all phases of the cancer research and delivery system. By supporting the use of innovative technology, clinical research, evidence-based medicine and shared best practices, US Oncology improves patient outcomes and offers a better patient experience. For more information, visit www.usoncology.com.
About Innovent Oncology
US Oncology expands patient access to high-quality, advanced cancer care through its comprehensive evidence-based medicine and patient care program, Innovent Oncology. Building upon physician and clinician expertise to create value in cancer care, Innovent Oncology uses a powerful reporting and analytic platform to increase efficiencies and reduce treatment variability across the entire patient care continuum. By applying US Oncology’s well-defined Level I Pathways treatment guidelines, proactive patient care management and support, and advance care planning, physicians can enhance the quality and consistency of patient care delivered in communities throughout the nation. The program also strives to align incentives between providers and payers to produce better patient outcomes and an improved patient experience. For more information, call 1-866-214-2194 or visit www.innoventoncology.com.
Milliman is among the world’s largest independent actuarial and consulting firms. Founded in 1947, the company currently has 52 offices worldwide. The New York City office was founded in 1965. Milliman employs over 2,400 people and has consulting practices in healthcare, employee benefits, property & casualty insurance, life insurance and financial services. Milliman serves the full spectrum of business, financial, government, union, education and nonprofit organizations. For further information, visit www.milliman.com
Jennifer Horspool Claire Crye
(281) 863-6739 (281) 863-6783
# # #