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Are you ready for the next wave of specialty care management?
The plan turned to NCH's comprehensive oncology program, which promotes
clinical efficacy, minimal patient side effects and favorable cost impact. National
Comprehensive Cancer Network's (NCCN) Drugs and Biologics Compendium, and
other nationally published drug compendia, are resources for NCH's pathway
content. The NCH pathways further refine the general compendia guidelines for
optimal efficacy, safety and cost.
"As NCH drafts pathway content, we rate the clinical evidence, consider toxicity
and lastly evaluate cost," says NCH Senior Medical Director Stanley Forston.
"Finally, we research what community physicians are generally using."
NCH'S independent Oncology Scientific Advisory board considers the draft
pathways content, then presents its recommendations to the company. A key
consideration, Dr. Forston, says, is making sure the pathways will be adopted
by physicians. "We consider it vitally important to engage and support
community-based oncology."
NCH collaborated with the MA plan to construct a high-performing,
narrower oncology network. Working with providers to make sure their
practice margins were protected, NCH created an alternative payment
model that encouraged quality and cost-efficiency.
The NCH oncology pathways resulted in $18 million in savings over four
years, with the group moving from 49% pathway compliance in the first
year to 78% compliance by the fourth year.
CARDIOLOGY QUALITY PROGRAM
ALIGNS PAYERS, PROVIDERS
NCH worked with another MA plan during its market launch, creating
a comprehensive cardiology and oncology program for its members.
NCH supported the MA plan beginning with its initial launch with 5,000
members in 2012, and it transitioned the model to a value-based program
supporting membership growth to over 30,000.
49%
78%
The group moved from 49%
pathway compliance in the first year
to 78% compliance by the fourth year.
