A recent study of the Cancer Care Quality Program (CCQP) treatment pathways found that an enhanced reimbursement to providers who adhere to on-pathway treatment regimens increased use of the drugs without changing the total care spending, supporting the payer’s efforts to move the needle on value-based care. That program has since led to the insurer’s launch of an oncology medical home this summer.
Elevance Health launched CCQP in 2014, rolling it out to 14 states through the next year (RSP 6/14, p. 3). Administered by Carelon Insights, the voluntary program provides enhanced reimbursement of $350 for a person’s initial on-pathway treatment and then $350 every month after for a maximum number of months as specified by CCQP. Those payments are in addition to reimbursement for office visits and drugs. There’s no penalty if a provider chooses an off-pathway regimen.
Researchers were trying to determine whether providers in the pay-for-performance (P4P) program were prescribing a CCQP-endorsed, evidence-based treatment regimen. They looked at pharmacy and medical benefit claims for people at least 18 years old diagnosed with breast, colon or lung cancer between July 1, 2013, and Sept. 30, 2017, and tracked them through March 30, 2018. More than 1,800 oncologists and 25,000 people were included across 14 states, and spending over a six-month episode period was evaluated.
According to the article, which was published on the Journal of Clinical Oncology’s website Oct. 7, Elevance Health’s program is the largest P4P program focused on the use of evidence-based oncology medications in the U.S. Over the study period, 97% of eligible providers opted to participate in CCQP.
Researchers found that prescribing an evidence-based regimen rose from 57.1% of patients to 62.2% of patients during the study period. In addition, spending on oncology drugs increased $3,339, and member out-of-pocket spending rose $253. However, “no significant changes in total health care spending” were detected.
Per the article, “Changing physician practice patterns is challenging. In the case of cancer drug prescribing, this may be a result, in part, of financial incentives in the buy-and-bill system, where physicians receive greater remuneration when prescribing higher-priced cancer drugs regardless of evidence. Our findings also revealed substantial variation in cancer drug prescribing. Physicians prescribed 402 unique drug regimens even though only 60 of those regimens were program-endorsed, evidence-based regimens.”
“We are not aware of interventions at a national scale that have been as effective in changing cancer drug prescribing patterns as CCQP,” maintains the article. “The success of CCQP in changing prescribing patterns is particularly relevant because P4P is widely used by insurers and health care delivery organizations as a means to improve quality, reduce costs, or both.”