Innovative Risk-Based Arrangement Could Change Cancer Care

Karen Amezcua

John Schwerkoske, MD

Blue Cross and Blue Shield of Minnesota will be jointly accountable with Minnesota Oncology, a practice in The US Oncology Network, for the overall cost of cancer care provided to Blue Cross members through a value-based risk arrangement.

The five-year collaboration, which began September 1, 2019, will include an agreed-upon set of quality metrics based on the latest scientific research and proven clinical guidelines. Minnesota Oncology will be responsible for ensuring continued alignment with evidence-based best practices and, as a result, will no longer be required to secure prior authorization from Blue Cross for coverage of selected services that are typically associated with high rates of overutilization.

The terms of the arrangement are based on the principle that effective outcomes for patients are determined by the quality of care provided-not the quantity. The agreement is competitive and proprietary; therefore, the specific terms of the agreement are confidential.

“The top issue across the industry is the sustainability of healthcare,” says Karen Amezcua, senior director of contracting, Blue Cross and Blue Shield of Minnesota. “We know that if healthcare is not affordable, access becomes limited, which leads to long-term impacts to population health. For more than a decade, value-based care has been seen as a potential solution to the unsustainable rise in healthcare costs. At Blue Cross, we’re working with provider partners to jointly drive affordability and quality in health care by transitioning from volume to value. We’re proud to have Minnesota Oncology as a partner in this journey.”

According to Amezcua, making the shift to paying for quality instead of quantity is important in all types of care, but it’s especially useful for complex conditions like cancer. “It allows providers to focus on the patients’ holistic needs and not be limited to services covered by the traditional fee-for-service payment model,” she says. “Paying for value in oncology is especially important, as it supports a comprehensive care model that provides individualized care coordination for patients with complex care needs. It also ensures that the best possible outcomes are occurring through medically necessary care at the right time and place.”

This program adds value by using value-based payment to move resources in a manner that improves the patient’s experience while maintaining physician independence. In the long run, this will be rewarding to healthcare executives and the community, according to John Schwerkoske, MD, president and medical oncologist at Minnesota Oncology.

“The agreement represents a transformation from a volume- to value-based payment model, driven by Minnesota Oncology and Blue Cross Blue Shield of Minnesota’s shared goal of delivering the best possible outcomes at a lower cost to cancer patients, many of whom struggle to afford their care, even with insurance,” says Schwerkoske. “The program structure reinforces the delivery of high-value care close to home in a community-based setting. Minnesota Oncology is committed to becoming part of the solution to the rising cost of healthcare in our state. In addition, data support delivery of care in a community-based setting is more affordable than hospital-based settings.”

Amezcua expects to see high-quality cancer care provided with an improved patient experience at a lower overall cost-as a result of fewer hospital admissions and ER visits.

With an enhanced focus on patient-centric healthcare, clinical staff at Minnesota Oncology will offer care coordination services on an individualized basis for Blue Cross members.

“This approach will help to ensure that the comprehensive care model already in place consistently delivers the best possible outcomes by providing appropriate, medically-necessary care at the right time and place,” says Schwerkoske. “Cancer patients face a big challenge, and we remain committed to providing comprehensive care including state-of-the-art therapies, precision medicine, genetic testing, palliative care, and access to clinical trials.”

Minnesota Oncology has a comprehensive care model: In addition to providers and nurses, social workers, dietitians, genetic counselors, and experienced oncology pharmacists who educate and monitor patients on IV and oral chemotherapy, the model also includes important patient care factors like remote symptoms monitoring, advance care planning, palliative care, sexual health, and survivorship, according to Schwerkoske.

This is a partnership that has been in the works for some time, as Blue Cross continues to look for ways to better manage costs while simultaneously improving the quality of care delivered to Blues members. The health plan announced a similar partnership with Mayo Clinic last year, a joint venture with North Memorial Health earlier this year, and, according to Amezcua, will continue to look for opportunities to collaborate with providers that share our goal of a more sustainable healthcare ecosystem in Minnesota.