UnitedHealthcare Tries Out New Program To Pay for Cancer Treatments

On Wednesday, health insurer UnitedHealthcare is expected to release details of a one-year pilot program to study a new payment method for cancer treatments, the New York Times reports.

The program aims to encourage physicians to follow standard treatment regimens, instead of choosing individualized or unproven tactics, which can include costly drug combinations, according to the Times.

Lee Newcomer, UHC's senior vice president for oncology, said that the goal of the program is to "separate oncologists' income from their drug selection" and "start searching for the best practices and move to them."

UHC's move comes as the federal health reform law has placed new pressure on providers to scale back spending.

Cancer care is a target because of its high cost. U.S. cancer care has been estimated to cost nearly $100 billion annually, while the average cancer patient's medical bill can reach up to $100,000 annually, the Times reports (Abelson, New York Times, 10/19).

Payment Details

The program -- which currently involves five oncology practices in five states -- is the first by a private insurer to examine "bundling" for cancer treatment, according to Kaiser Health News.

Under the program, UHC will make a one-time payment for each patient's complete course of cancer treatment for common cancers, such as those affecting the lungs, breasts and colon. Physicians also will receive a case management fee. The participating practices will select the course of treatment for each patient.

Physicians in the program can choose to administer drugs not included in the treatment regimen they initially select, and UHC will pay them based on the medications' actual sales price, KHN reports. Only treatments given by injection or infusion in physician offices will qualify for the payments.

Drugs taken orally -- which are a smaller but increasingly popular part of cancer treatments -- can be obtained by patients at pharmacies. Physicians do not bill for oral drugs.

UHC said the program will be reviewed based on:

• Patients' progress in terms of the number of emergency department visits they make;
• Side effects they experience; and
• The outcomes from the treatment regimens that are deemed most suitable for their particular type of cancer.

UHC officials said that it is unlikely that the program will affect patients' cost-sharing (Appleby, Kaiser Health News, 10/20). However, some critics have said the new program is a step toward denying patients additional care or the latest treatments, or rationing of care at the end of life.

Several Insurers Weighing Similar Payment Schemes

At least two other large insurance companies -- Aetna and WellPoint -- also have launched similar payment initiatives to coordinate and manage cancer care, while several regional insurers in California, Pennsylvania, Washington and other states are discussing special payment limits with physicians and clinics, the Times reports (New York Times, 10/20).