The collaboration centers on using bundled payments, which reimburse 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 payment model is designed to reward care providers who deliver better outcomes, while giving patients greater value and a better overall care experience.
This will be a three-year pilot between Moffitt and UnitedHealthcare that focuses on curing early-stage lung cancer in patients. The program includes surgery and radiation therapy bundles that were developed by UnitedHealthcare and Moffitt. The bundles translate evidence-based guidelines into safe, effective, individualized treatments for every patient with the goal of reducing variation in care, a key element of a bundle program.
“UnitedHealthcare has been a wonderful partner in exploring new ways to improve the cancer care experience of our patients,” said Alan F. List, M.D., Moffitt president and CEO. “This model is based on clinical pathways that we have developed at the cancer center to provide a basis for health care providers to evaluate best practices, outcomes information and cost of care. The pathways enable us to provide patients with superior outcomes at a lower cost. This lung cancer payment model will provide important information to both Moffitt and UnitedHealthcare about how to improve care and reduce cost.”
Similar payment models have successfully reduced overall costs while enhancing 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.
A recent 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 opportunities to implement it. 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.
“Moffitt Cancer Center has a long-standing culture of quality improvement, making it an ideal partner for implementing this bundled payment program that rewards improved quality and affordable cancer care,” said Lee N. Newcomer, M.D., UnitedHealthcare’s senior vice president, Oncology and Genetics. “Our organizations are working together to promote more patient-centric, evidence-based care, and this bundled payment model is an important part of UnitedHealthcare’s value-based programs that are shifting how we collaborate with care providers.”
The bundled payment program was launched Oct. 1, 2016, and covers Moffitt patients with lung cancer who are enrolled in certain employer-sponsored benefit plans insured or administered by UnitedHealthcare.
“Moffitt clinicians have developed extensive clinical pathways using evidence based practice. Using these guidelines has led to improved quality and better outcomes for our patients,” said Scott Antonia, MD, PhD, chair of Moffitt’s Department of Thoracic Oncology. “Our lung cancer patients benefit from the highest quality of care and innovation, but these partnerships ensure we continue to focus on improving the overall coordination of care for our patients. We are excited about this new partnership with United, it represents another way that Moffitt is leading the way in cancer care.”
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 more than tripled since 2011 to nearly $52 billion, and are expected to reach $65 billion by the end of 2018.
The National Cancer Institute estimates costs for cancer therapy in 2010 reached $125 billion, and the figure is projected to exceed $200 billion by 2020.
About Moffitt Cancer Center
Moffitt is dedicated to one lifesaving mission: to contribute to the prevention and cure of cancer. The Tampa-based facility is one of only 47 National Cancer Institute-designated Comprehensive Cancer Centers, a distinction that recognizes Moffitt’s excellence in research, clinical trials, prevention and cancer control. Moffitt is the No. 6 cancer hospital in the nation and has been listed in U.S. News & World Report as one of the “Best Hospitals” for cancer care since 1999. Moffitt devotes more than 2.5 million square feet to research and patient care. Moffitt’s expert nursing staff is recognized by the American Nurses Credentialing Center with Magnet® status, its highest distinction. With more than 5,200 team members, Moffitt has an economic impact in the state of $2.1 billion. For more information, call 1-888-MOFFITT (1-888-663-3488), visit MOFFITT.org, and follow the momentum on Facebook, Twitter and YouTube.
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 1 million physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. UnitedHealthcare 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.