Anthem Blue Cross and Blue Shield in Ohio will be introducing an
innovative quality initiative beginning July 1 that will allow
oncologists to compare planned cancer treatment regimens against
evidence-based clinical criteria and potentially receive enhanced
The WellPoint Cancer Care Quality Program, developed in collaboration
with AIM Specialty Health, a separate company, identifies certain cancer
treatment pathways selected based upon current medical evidence,
peer-reviewed published literature, consensus guidelines, and Anthem's
clinical policies, to support oncologists in identifying cancer
treatment therapies that are highly effective and provide greater value.
Today, cancer care is challenged by the following:
"This program - while sharing best practices and evidence-based medicine
- also helps to support oncologists who require lrge staffs to treat
these complex patients and provides the practice with enhanced
reimbursement to offset the lower fees they receive when prescribing
less expensive drugs," said Dr. Barry Malinowski, Vice President and
Medical Director for Anthem in Ohio.
All fully-insured and self-insured members, Medicare Advantage members
and national account members who live in states where the program has
been implemented are part of this program.
Providers will continue to be reimbursed for visits and cancer drugs
according to the terms of the member's health plan regardless of whether
a treatment is on pathway; however, only pathway regimens are eligible
for enhanced reimbursement.
"Chemotherapy makes up 25 percent of the costs to treat health plan
members who have cancer, and this percentage is growing faster than any
other part of care," said Malinowski. "It's clear that our approach to
cancer therapy is an answer in making a positive impact on quality and
in slowing the rate of these increases to keep premiums as affordable as
1.Wu 2012, Bilimoria 2009, Spencer 2008, Neuss 2013, Malin
2.Express Scripts, Drug Trend Report 2013, page 25.
About Anthem Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield is the trade name of Community
Insurance Company, an independent licensee of the Blue Cross Blue Shield
Association. ®ANTHEM is a registered trademark of Anthem
Insurance Companies, Inc. The Blue Cross and Blue Shield names and
symbols are registered marks of the Blue Cross and Blue Shield
Association. Additional information about Anthem Blue Cross and Blue
Shield in Ohio is available at www.anthem.com.
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