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Anthem Blue Cross and Blue Shield's new quality initiative aims to improve cancer outcomes, promote access to evidence-based and cost-effective care
[June 25, 2014]

Anthem Blue Cross and Blue Shield's new quality initiative aims to improve cancer outcomes, promote access to evidence-based and cost-effective care

MASON, Ohio --(Business Wire)--

Anthem Blue Cross and Blue Shield in Ohio will be introducing an innovative quality initiative beginning July 1 that will allow oncologists to compare planned cancer treatment regimens against evidence-based clinical criteria and potentially receive enhanced reimbursement.

The WellPoint Cancer Care Quality Program, developed in collaboration with AIM Specialty Health, a separate company, identifies certain cancer treatment pathways selected based upon current medical evidence, peer-reviewed published literature, consensus guidelines, and Anthem's clinical policies, to support oncologists in identifying cancer treatment therapies that are highly effective and provide greater value.

Today, cancer care is challenged by the following:

  • Up to 1 in 3 people treated with chemotherapy do not receive a treatment plan that is consistent with current medical evidence and best practices. 1
  • Costs of new cancer therapies are growing by 25 percent annually.2
  • As many as 180 medical journals publish new studies on cancer monthly and quarterly, making it difficult for oncologists to stay up-to-date.
  • Cancer drugs - unlike other therapies - are purchased directly by practices and hospitals from manufacturers or distributers. Health insurers generally reimburse practices a set percentage above the cost of the drug.

"This program - while sharing best practices and evidence-based medicine - also helps to support oncologists who require lrge staffs to treat these complex patients and provides the practice with enhanced reimbursement to offset the lower fees they receive when prescribing less expensive drugs," said Dr. Barry Malinowski, Vice President and Medical Director for Anthem in Ohio.

All fully-insured and self-insured members, Medicare Advantage members and national account members who live in states where the program has been implemented are part of this program.

Providers will continue to be reimbursed for visits and cancer drugs according to the terms of the member's health plan regardless of whether a treatment is on pathway; however, only pathway regimens are eligible for enhanced reimbursement.

"Chemotherapy makes up 25 percent of the costs to treat health plan members who have cancer, and this percentage is growing faster than any other part of care," said Malinowski. "It's clear that our approach to cancer therapy is an answer in making a positive impact on quality and in slowing the rate of these increases to keep premiums as affordable as possible."

1.Wu 2012, Bilimoria 2009, Spencer 2008, Neuss 2013, Malin 2006

2.Express Scripts, Drug Trend Report 2013, page 25.

About Anthem Blue Cross and Blue Shield

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company, an independent licensee of the Blue Cross Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Ohio is available at Also, follow us on Twitter (News - Alert) at, on Facebook (News - Alert) at, or visit our YouTube (News - Alert) channel at

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