Abstract Types

Clinical Review Abstract

Late-Breaking Abstract

Trials in Progress Abstract

Abstracts selected for publication but not presentation at the Annual Meeting

Abstracts granted an exception in accordance with ASCO's Conflict of Interest Policy

Oncology medical home: Payer return on investment (ROI).


Health Services Research

2013 ASCO Annual Meeting

Abstract No:

J Clin Oncol 31, 2013 (suppl; abstr e17582)

Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2013 Annual Meeting but not presented at the Meeting, can be found online only.

Author(s): Winston Wong, Joseph Cooper, Daniel Winn, Tim Olson, Ram Swarup Trehan, Jeffrey A. Scott, Bruce A. Feinberg; CareFirst BlueCross BlueShield, Baltimore, MD; Cardinal Health Specialty Solutions, Dublin, OH; CareFirst BlueCross Blue Shield, Baltimore, MD; Greater Washington Oncology Associates, Rockville, MD

Abstract Disclosures


Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of care. We analyzed payer ROI after year +1 of the medical home program. Methods: The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services allowing physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. Physicians were encouraged to commit to an intensive continuous quality improvement (CQI) program, which included an end-of-life initiative and a post chemotherapy nurse call-back program that would lower costs by decreasing emergency room and hospital admissions. Physicians participating in the first CFBCBS pathway program were eligible to join the medical home program; physicians who chose not to join made up the control group. Data were collected from April 2010 to March 2012. Medical home ROI was calculated by subtracting the total weighted cost per patient for the medical home group from the total risk-adjusted cost per patient for the control group multiplied by the total number of patients in the medical home program. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. The control group was comprised of 39 practices (103 physicians, 2031 patients). Total weighted cost per patient for the medical home program for year +1 was $26,702. Risk-adjusted cost per patient for the control group for year +1 was $30,670. The medical home program provided a gross savings of $2,016,868 compared to the first CFBCBS pathways program. Conclusions: Significant savings can be achieved in a provider group already compliant with a mature pathways program. A CQI program can directly and favorably impact patient outcomes and ROI via presumed reduction in emergency room and hospital admissions.


  Other Abstracts in this Sub-Category:


1. Financial distress, communication, and cancer treatment decision making: Does cost matter?

Meeting: 2013 ASCO Annual Meeting Abstract No: 6506 First Author: Y. Zafar
Category: Health Services Research - Cost


2. Determining value of high cost cancer therapies and discussing cost of cancer care: The patient perspective.

Meeting: 2013 ASCO Annual Meeting Abstract No: 6512 First Author: S. Rajguru
Category: Health Services Research - Cost


3. Adoption of robot-assisted surgery and its impact on treatment patterns for newly diagnosed localized prostate cancer.

Meeting: 2013 ASCO Annual Meeting Abstract No: 6513 First Author: Y. T. Shih
Category: Health Services Research - Cost