Managed Healthcare Executive - April 2009 - (Page 20) { S P E CI AL RE PO R T} members with enough unmet need to warrant case management. Intervention included education, nurse visits, frequent interaction and goal-oriented care plans. The program continues but now has been expanded to any CalPERS members with a cancer diagnosis. Andrew Halpert, MD, senior medical director of Blue Shield, says that although the program is run by nurses, the oncologist is still the leader of care. He notes that physicians are generally not case managers, while nurses can e ectively reinforce information given to patients. He also foresees that PCPs will assume a larger role in cancer care for those patients with fewer critical needs. A 2007 study in the American Journal of Managed Care, co-authored by Dr. Halpert, shows that patients who received patient-centered management—end-of-life services, pain management education, patient advocacy and provider coordination—can sharply reduce utilization and costs without shortening life, when compared with usual management of patients with a life-limiting diagnosis and comorbidities. The average combined utilization cost for the patient-centered group was $49,742 per patient versus $68,341 consumed by patients receiving usual care. Those patients receiving the additional management had substantially fewer hospital admissions (38%) and emergency room visits (30%) but showed increased utilization of home and hospice care (22% and 62%, respectively). CALL TO ACTION Common Cancer Types, 2008 Cancer Type Skin (nonmelanoma) Lung (including Bronchus) Prostate Breast (female/male) Colon and Rectal (combined) Bladder Non-Hodgkin Lymphoma Melanoma Kidney (Renal Cell) Leukemia (all) Endometrial Pancreatic Thyroid Estimated New Cases >1 million 215,020 186,320 182,460/1,990 148,810 68,810 66,120 62,480 46,232 44,270 40,100 37,680 37,340 Estimated Deaths <1,000 161,840 28,660 40,480/450 49,960 14,100 19,160 8,420 11,059 21,710 7,470 34,290 1,590 Source: National Cancer Institute In response to a call for action from the IOM in 2005, Anthem Blue Cross developed a program, which is being piloted in ve states, to improve lifelong continuity and coordination of care for cancer survivors. The initiative, called Journey Forward, is a collaboration created by WellPoint, Genentech, the University of California at Los Angeles Cancer Survivorship Center and the National Coalition for 20 APRIL 2009 Cancer Survivorship. One of the objectives is to bring PCPs into the fold for survivorship care. “Oncologists are more e ective with treatment and complex drug management, while PCPs are more equipped to handle the long-term psychosocial needs of the disease,” says Michael J. Belman, MD, medical director, Anthem Blue Cross. Jennifer Hausman, clinical research manager for Anthem, adds that PCPs feel more comfortable working with cancer patients when they receive an end-of-treatment summary. The initiative o ers kits, explaining the importance of follow-up care plans to patients, tools for providers to develop such plans, and interactive tools for patients to participate in and monitor their own care. The information is tailored for oncologists, primary care providers and patients with colon and breast cancer, however it will ultimately be expanded to more practitioners and types of cancer. A signi cant addition to the National Comprehensive Cancer Network is a section of guidelines dedicated to survivorship. The guidelines provide recommendations for long-term follow-up care of patients treated for colorectal cancer. The guidelines also outline how to manage possible longterm side e ects of treatment, routine screening and monitoring, healthy lifestyles and wellness counseling—helping patients make a smooth transition back to their PCPs. Disease management, a burgeoning compartment of care for many chronic diseases, is still on the back burner for cancer, even though cancer is becoming more of a chronic condition. Only 27% of plans indicate that they o er a disease management program for cancer patients; however, nearly half say they believe such a program would improve outcomes and compliance while reducing disability in patients, according to the 2008 Genentech Oncology Trend Report. Only 27% of employers o er oncology disease management programs, making the disease category 10th on a list developed by DMAA: The Care Continuum Alliance. MHE
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