Researchers evaluated the treatment regimens based on the number of emergency-room visits, incidence of complications, side effects and, most importantly, health outcomes to determine which treatment regimens do the best job of helping to fight cancer. By measuring the comparative effectiveness of different treatment options, the program aimed to uncover best practices, and identify and reduce unnecessary drug administration that does not improve the patient’s health.The upfront fee to the oncologists covered the standard treatment period, which is typically six to 12 months. In cases of cancer recurrence, the bundled payments were renewed every four months during the course of the disease, which allowed the doctor to continue overseeing his or her patient’s care even if drug therapy was no longer effective. The payments also were continued for patients who were no longer receiving chemotherapy or who enrolled in hospice care. This approach was designed to reward oncologists at current levels for patient care while simultaneously severing the link between drug selection and income. Physicians were incented with the ability to earn an increased episode payment by improving their results. UnitedHealthcare did not play a role in determining which treatment plan the oncologists chose. The study, conducted between October 2009 and December 2012, covered 810 cancer patients with breast, colon and lung cancer, and examined the difference in cost before and after the payment change. The total cost of medical care for patients in the study was $64.76 million, a 34 percent reduction in medical costs for a savings of $33.36 million. The cost of chemotherapy medications, however, was $13.46 million higher for the episode group than for the control group, but the tested pilot model still produced the 34 percent overall costs savings. The study used a quality improvement incentive to reduce the total cost of care and improve outcomes. While the goal of the study was to remove the link between drug selection and medical oncology outcomes by providing incentives for decreased chemotherapy costs, drug costs still were higher. This finding demonstrates that the bundled payment approach was able to reduce overall medical spend through other channels. The study was not designed to determine specifically how the cost savings were achieved, though analysis suggested the primary difference was hospitalizations.
“The episode payment project yielded significant savings for the treatment of cancer patients without any measurable effect on the health outcomes for patients,” said Dr. Gould, who participated in the pilot. “The health care community needs to embrace new approaches to payment if we want to ensure the sustainability of our health care system for future generations.”About UnitedHealthcare UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with more than 800,000 physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. Globally, UnitedHealthcare serves more than 45 million people in health benefits and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company. Click here to subscribe to Mobile Alerts for UnitedHealth Group.