Published December 15, 2014
The University of Texas MD Anderson Cancer Center and UnitedHealthcare have launched a pilot to explore a new cancer care payment model for head and neck cancers that focuses on quality patient care and outcomes. The collaboration is among the first in using bundled payments in a large, comprehensive cancer center.
The bundled payment method reimburses a care provider or hospital for a defined episode of care under a single fee or payment. This is a shift away from the common fee-for-service structure in which a care provider is paid for each treatment, drug, appointment or test.
The program is based on MD Anderson’s extensive mapping of the complex tests, treatments, follow-up care and supportive services required for the most common head and neck cancer diagnoses. The pre-priced payment provides an incentive to focus on the essential elements of care and to avoid unnecessary steps. This careful mapping is expected to produce improved patient outcomes, lower costs and a better quality of life for patients.
Similar payment models have shown to help reduce overall costs while providing for continuity of care and improving outcomes for patients. UnitedHealthcare launched a similar pilot in 2010 involving 810 breast, colon and lung cancer patients who were treated at five medical oncology groups around the United States.
The July 2014 issue of Journal of Oncology Practice featured the results of that study, which showed cancer costs were cut by a third and quality was improved. Those results prompted UnitedHealthcare to expand the bundled payment model and explore more complete models like the one at MD Anderson. The report, “Changing Physician Incentives for Affordable, Quality Cancer Care: Results of an Episode Payment Model,” demonstrates the potential effectiveness of new approaches to the current “fee-for-service” payment model for cancer therapy.
The new three-year pilot will be conducted in MD Anderson’s Head and Neck Center for up to 150 patients newly diagnosed with cancers of the salivary glands, oral cavity (including the mouth, lips, tongue, soft palate), throat and larynx, and who are enrolled in certain employer-sponsored benefit plans insured or administered by UnitedHealthcare.
Eight bundled payment models have been developed by MD Anderson and UnitedHealthcare for the program. Each bundled payment model was developed for the research-based clinical practices and protocols that have been created and refined over decades at the cancer center.
“For the last five years, MD Anderson and its Institute for Cancer Care Innovation have been looking at how to best approach a single price for treating cancers. It is a complex question because cancer is a complex disease and each patient unique,” said Thomas W. Feeley, M.D., head of Anesthesiology and Critical Care, and head of the institute. “Bundled pricing is something that patients and care providers want, and this is our first opportunity to better understand how we can manage costs without sacrificing quality care and patient outcomes.”
“Our partnership with MD Anderson Cancer Center marks an important step toward expanded bundled care payment models and away from the traditional fee-for-service payments for oncology care,” said Lee N. Newcomer, M.D., United Healthcare’s vice president, oncology. “Our recently completed pilot shows that these creative new cancer care payment models can reduce health care costs while improving patient outcomes. MD Anderson’s work with value-based workflows makes them a natural partner for bundled payments.”
Bundled payments are one of the many different ways UnitedHealthcare is working with care providers to transition to value-based reimbursement methods, which emphasize quality and patient outcomes over the volume of procedures performed. Care providers are showing strong interest, as UnitedHealthcare’s total care provider reimbursements that are tied to a variety of value-based arrangements have nearly tripled since 2011 to $36 billion, and are expected to reach $65 billion by the end of 2018.
“Patients enrolled in the pilot will not have any change or adjustment in their care as a result of the payment structure,” said Randal S. Weber, M.D., professor and chair of the Department of Head and Neck Surgery. Patients will receive the same care, approach, treatment and diagnostics for their disease as those who are not part of the program. The new payment model is designed to bill patients just once for their cancer treatment at MD Anderson, and because the cost of the tests, treatment and other services are priced upfront, they will know the cost of care early in their treatment program.
The National Cancer Institute estimates costs for cancer therapy in 2010 reached $124.6 billion, and the figure is projected to reach as high as $207 billion in 2020. Cancer therapy, including related pharmaceutical costs, currently accounts for 11 percent of UnitedHealthcare’s commercial health plan spend.
UnitedHealthcare selected MD Anderson’s Head and Neck Center for the pilot because of its multidisciplinary quality care, and its work with Harvard Business School professors Michael E. Porter, Ph.D., and Robert S. Kaplan, Ph.D., leading academics in studying quality in health care and accounting methods that support quality measurement and bundled payment.
About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 41 comprehensive cancer centers designated by the National Cancer Institute (NCI). For the past 25 years, MD Anderson has ranked as one of the nation's top two cancer centers in U.S. News & World Report's annual "Best Hospitals" survey. MD Anderson receives a cancer center support grant from the NCI of the National Institutes of Health (P30 CA016672).
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, military service members, retirees and their families,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 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. For more information, visit UnitedHealthcare at www.uhc.com or follow @myUHC on Twitter.