Illinois Practice Shows Empowering Oncologists Can Reduce Cancer Drug Spend

An independent cancer practice in Illinois has demonstrated that empowering oncologists via peer discussion groups and rapid access to cost and outcome data may be a key to slowing the growth of cancer drug spend.

In the May issue of JCO Oncology Practice, Cancer Care Specialists of Illinois (CCSI) and New Century Health (NCH) revealed that by deploying high-value clinical pathways in combination with regular, data-driven peer discussions about costs and outcomes, CCSI’s oncologists reduced their median drug spend by 13.5% as compared to that of other Oncology Care Model (OCM) practices. The cost savings equate to about $3.5 million over 15 months, a reduction the practice achieved without any prior authorization by payers.

“The average oncologist doesn’t have the time or resources to determine which treatment regimens offer the best value. The New Century Health clinical pathway model has allowed us to compare both the efficacy and costs of various drug combinations with two mouse clicks on our electronic medical record desktop rather than hours of clinical research,” said Dr. James Wade, founder of CCSI. “It’s a faster way to identify optimal treatments that are peer-reviewed for efficacy and value. And because we’re participating in OCM, Medicare may share with us savings garnered from our physicians making wiser choices.”

CCSI chose New Century Health’s high-value clinical pathway approach to capture episode-based savings in OCM. The NCH pathway library is thoroughly researched by an experienced interdisciplinary team and is updated quarterly with external guidance from a scientific review board comprised of nationally recognized practicing oncologists, pharmacists and patient advocates.

CCSI’s physicians met biweekly to review treatment plans, adherence to the clinical pathways, and drug utilization for opportunities to reduce drug costs without sacrificing quality of care. One such opportunity involved two drug combinations that were recently approved for patients with non-small cell lung cancer, one with paclitaxel and the other with nab-paclitaxel. Treatment effects were proven similar—but the paclitaxel-containing regimen was far less expensive than the regimen containing nab-paclitaxel, and thus the preferred care pathway would recommend the former.

While clinical pathways were essential to CCSI’s success, it was also critical to address the perverse incentives that can impede efforts to rein in spending. In traditional fee-for-service reimbursement models, the average oncology practice relies on drug markups for up to 30% of its revenues; oncologists who seek to use lower-cost drugs outside of alternative reimbursement approaches may run into financial sustainability issues. Tying care pathways to reimbursement rewards the practice for choosing the lower-cost option while ensuring patients receive the most efficacious therapies.

Most OCM participants pursue savings through care coordination efforts such as reducing avoidable emergency department visits. Drug spend, which makes up more than 50% of OCM participant costs, is rarely addressed because most oncologists don’t believe they can move that needle.

“As oncologists, we’ve been abdicating responsibility for a huge driver of financial toxicity. But our society cannot sustain these costs, and our patients are choosing between medication and food. CCSI’s oncologists proved that informed, empowered physicians can play a huge role here,” said Dr. Andrew Hertler, chief medical officer for New Century Health.

Hertler doesn’t foresee the need for such interventions decreasing in the aftermath of today’s COVID-19 crisis. As the pandemic subsides and society grapples with the long-term costs of the response, the need to rely on clinical evidence to guide care regimens and manage spending may be even greater than it was during the study.

Highlights from the CCSI measurement period from Oct. 2017 through Dec. 2018 include:

• By quarter 1 of 2019, CCSI had decreased its drug spend relative to the OCM median by 13.5%, equivalent to about $250,000 saved per medical oncologist over the 15 months.
• Total cost of care was reduced by 5% as compared with the OCM median.
• Clinical pathway adherence increased from a baseline of 69% to 81%.

“Succeeding in alternative payment models depends on getting to value quickly, but it also means ensuring our physicians retain agency over their patients’ treatment. The care pathway model encouraged peer discussions, and we were able to make these changes together as a team rather than having them imposed on us from the outside,” CCSI’s Dr. Wade said.

The full paper laying out CCSI’s approach and results can be accessed through JCO Oncology Practice.

About Cancer Care Specialists of Illinois

Cancer Care Specialists of Illinois is the largest interdisciplinary oncology hematology practice in Illinois outside of Chicago. CCSI—and its more than 20 board-certified physicians—is nationally recognized as an outstanding cancer care practice and recipient of Quality Oncology Practice Initiative (QOPI) Certification from the American Society of Clinical Oncology. For more, visit cancercarespecialists.org.

About New Century Health

New Century Health is the nation's leading specialty care management company, with special focus on cancer and cardiology patients. New Century Health partners with specialty providers and health plans to provide them with the clinical decision and population health management tools to ensure that cancer and cardiology patients receive the highest quality, most affordable care. New Century Health is a wholly owned subsidiary of Evolent Health. To learn more about New Century Health, please visit newcenturyhealth.com.

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