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New Research Proves Clinical Pathways Can Reduce Cancer Care Costs And Improve Quality While Increasing Physician Reimbursement

DUBLIN, Ohio, May 21, 2013 /PRNewswire/ -- With the cost of cancer care projected to increase to $170 billion by 2020 1, many in the healthcare industry are looking for ways to curb that cost curve – while maintaining quality of care for cancer patients and preserving fair compensation for physicians. New research being featured later this month in poster presentations and abstracts at the 49 th Annual Meeting of the American Society of Clinical Oncology (ASCO) proves that it is possible to meet all three of these seemingly contrary goals.  

Cardinal Health Specialty Solutions and CareFirst BlueCross BlueShield (CareFirst), one of the largest health insurers in the Mid-Atlantic, recently completed a series of studies on the effectiveness of the nation's first clinical pathways program for oncology, which they jointly launched in 2008.  Physicians within the CareFirst network worked together to develop clinical pathways – or evidence-based treatment regimens – for the treatment of breast, lung and colon cancers.  

The new research shows that through the use of the Clinical Pathways program, CareFirst reduced its overall costs for treating breast, lung and colon cancers by 15 percent. These savings were primarily achieved through a 7 percent decline in emergency room visits, shorter lengths of stay in the hospital, increased use of generic medications and more appropriate use of chemotherapy. Although the overall drug spend was reduced, the reimbursement to physicians increased for both branded and generic drugs, and physicians received higher reimbursement overall.

The authors of the research contend that payor-physician collaboration was a significant factor behind the success of this Clinical Pathways program.  

"These positive results prove that when implemented collaboratively, with physician input and buy-in, our Clinical Pathways can create a new paradigm for the delivery of cancer care – one in which all stakeholders can win," said Bruce Feinberg, D.O., vice president and chief medical officer of Cardinal Health Specialty Solutions.  

Feinberg explained that these Clinical Pathways were created by and for physicians within the CareFirst network, not by an outside entity. He also asserts that this collaboration was a leading factor for the program's high rate of physician participation and 95 percent pathways compliance rate. For example, participating physicians were less likely to administer complex chemotherapy in late-line treatment, and when clinical evidence did not support it.

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