Blue Cross Blue Shield of New Mexico has launched a pilot program geared to helping cancer patients and their families find the right care, navigate through it and better cope with the multiple issues cancer patients face.
The program is also seen as a template for future oncology payment models to providers.
Blue Cross is partnering with New Mexico Oncology Hematology Consultants, better known as the New Mexico Cancer Center, to carry out the program, which will, among other things, answer patients’ questions, coordinate various doctors and specialists, make sure patients have better outcomes, and drive down the frequency and costs of needless ER use and hospitalizations.
The pilot phase of the Oncology Quality Program is available to commercial group members, said John Cook, vice president of network services. To qualify, patients must be diagnosed with one of the following types of cancer: breast, lung, colon, pancreatic, lymphoma, melanoma and thyroid.
Cook said a “relatively small” group of cancer patients covered by the insurer would be eligible for the program, which will run for 12 to 18 months. If the new treatment model proves successful, the insurer is considering replicating it for other lines of business, such as Medicare and Medicaid, Cook said.
The insurer has yet to set a specific budget for the pilot program.
Blue Cross Blue Shield of New Mexico spends more per member, per month on all cancer treatments than any other single medical diagnosis category for its commercial members, he said.
“The cost of chemotherapy agents can run $30,000 to $50,000 per year,” per patient, depending on the severity of the cancer, Cook said.
According to UnitedHealthcare data, drugs themselves account for only 24 percent of direct cancer costs. Hospital and outpatient facilities account for 54 percent of costs, and physician fees account for 22 percent.
Patients must also pay for medicine that mitigates the side effects of chemotherapy, pay provider and facility fees and often lose income when they miss work or lose their jobs.
In the pilot program, Blue Cross will paying an additional fee for “value-based care” of the member/patient. For example, patients have access to immediate phone triage staffed around the clock to help patients manage their symptoms.
The effort is being led by Dr. Barbara McAneny, who co-founded New Mexico Oncology Hematology Consultants. She said the pilot program dovetails with the oncology medical home concept she created and shared with six other cancer centers around the country. That nearly $20 million project was funded by the Centers for Medicare and Medicaid Innovation.
“Blue Cross Blue Shield really stepped up” to keep cancer patients feeling as well as they can possibly be with the program, said McAneny.
The patient care coordination fee to New Mexico Cancer Center will vary, depending on where the patient is “in their cancer journey,” said McAneny.
“Intervening early and aggressively before side effects are out of hand” is how she describes the best practices model of her business and the guiding principle of the pilot program. A medical home, particularly for cancer patients who suffer side effects from chemotherapy treatment and other drugs, is intended to intervene in a patient’s care before they become so sick they have to go to a hospital ER, which is more expensive.
“Cancer is not a 9-to-5 disease,” she said of patients needing treatment, encouragement and support in the evenings and weekends.