Managed Care - September 2008 - (Page 49)

PLAN WATCH For instance, pain assessment is a big part of the QOPI. Three questions patients are asked are • Were you asked to rate your pain, in terms of percentage, by the second office visit? • Was the intensity of your pain, in terms of percentage, quantified by the second office visit? • If you are a patient with moderate to severe pain, were you given documentation that your pain was assessed? “Oncologists participating in the ASCO QOPI initiative will receive information back from ASCO about how their office practices compare nationally to their peers,” says Share. “They will be provided aggregate information on whether they did or did not assess pain at a random sampling of their patient visits. Oncologists and their partners will be able to take this information and modify their care processes.” The information being collected focuses on chemotherapy planning and side effects, pain assessment and control, and specific measures related to the management of colon and rectal cancer, non-Hodgkin’s lymphoma, and nonsmall-cell lung cancer. Hoping past is prologue In deciding to launch a program through which it helps to improve care and reduce costs for cancer patients, Blue Cross Blue Shield of Michigan officials took heart from a program the company launched for patients undergoing cardiac angioplasty. That program, called Value Partnerships, saw • A 27 percent reduction in hospital deaths • A 19 percent reduction in heart attacks • A 22 percent reduction in unplanned coronary artery bypass surgery • A 57 percent reduction in rate of kidney failure after angioplasty • Savings estimated at $8 million annually statewide Potential savings The bottom line here is improved clinical outcomes, though the insurer admits that there may be some savings as well. “BCBSM spent $784 million for oncologyrelated services in 2006, which was 10 percent over the previous year and the largest area of expenditures,” says Share. “Comparative performance reports regarding concordance of practice patterns with generally accepted standards of care have been successfully used to guide efforts to improve quality in other areas of care. These efforts have often been associated with improvements in the efficiency of care as well.” Share admits that he doesn’t know if this will be the case in cancer care, but it’s worth a try. “There are potential opportunities, such as optimizing efficiency of use of blood cell stimulating agents and targeting new, high-cost anticancer agents to those patients with evidence of potential benefit, for example B Herceptin for those who have relevant cell receptors.” To take another example, information gathered on how to prevent dehydration caused by chemotherapy could reduce the number of hospital admissions. Data collection began in May, and BCBSM officials say that they will not know the exact savings for about 18 months, although early results may be released this month. Oncologists and BCBSM officials worked for about a year and a half, reviewing possible means for improving cancer care in the state. “After considering dozens of options, the team decided the best starting place is the ASCO quality measure system,” says Share. Unknown In many ways, it was stepping into uncharted territory. “It isn’t known how much variation there is in community-based cancer care practice nor how much opportunity there is to increase concordance with evidence-based practice or to achieve cost savings while doing so,” says Share. “But cancer is all too common and cancer care is both challenging for patients and costly. It makes sense to first learn whether there are opportunities for improvement and then to act on them. Since health care is complex and evolving, there is every reason to think that cancer care can be improved, as is true of any complex human endeavor.” MC There is every reason to believe that cancer care can be improved, asserts David Share, MD, MPH, of Blue Cross Blue Shield of Michigan, which spent $784 million on oncology services in 2006. SEPTEMBER 2008 / MANAGED CARE 49

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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