Uwe - my understanding is that UnitedHealth and Medicare have taken
rather different approaches to payment reform for cancer. In the United
program, the incentive to over or underprescribe is being removed from
the oncologists altogether:
http://www.unitedhealthgroup.com/newsroom/news.aspx?id=efeefe23-c20a-47b
1-ad72-73bba875d46c 

Whereas Medicare retained the basic incentive structure and merely cut
the payment rates. Here is what that produced, according to Jacobson et
al:  

"HEALTH AFFAIRS ABSTRACT - The Medicare Prescription Drug, Improvement,
and Modernization Act, enacted in 2003, substantially reduced payment
rates for chemotherapy drugs administered on an outpatient basis
starting in January 2005. We assessed how these reductions affected the
likelihood and setting of chemotherapy treatment for Medicare
beneficiaries with newly diagnosed lung cancer, as well as the types of
agents they received. Contrary to concerns about access, we found that
the changes actually increased the likelihood that lung cancer patients
received chemotherapy. The type of chemotherapy agents administered also
changed. Physicians switched from dispensing the drugs that experienced
the largest cuts in profitability, carboplatin and paclitaxel, to other
high-margin drugs, like docetaxel. We do not know what the effect was on
cancer patients, but these changes may have offset some of the savings
projected from passage of the legislation. The ultimate message is that
payment reforms have real consequences and should be undertaken with
caution. Health Affairs, July 2010; 29(7): 1391-1399." 

Best wishes

Simon


Simon Stevens
President, Global Health, UnitedHealth Group
Chairman, UnitedHealth Center for Health Reform & Modernization
email [log in to unmask]

-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Uwe E. Reinhardt
Sent: Thursday, October 21, 2010 9:59 AM
To: [log in to unmask]
Subject: Re: today's spotlight


This is idea had come from government, pictures of Hitler would come out
of the woodwork. I kid you not -- see the attached.

Medicare did reform the payment of oncologists a little while ago.
Previously Medicare "reimbursed" physicians for drugs they used at the
"average wholesale price" (AWP reported by drug companies, a wholly
fictitious number. The companies then gave physicians large discounts of
that AWP, which gave physicians incentives to favor one drug over the
other. As I understand it, now Medicare reimburses physicians only for
what the drug companies actually got paid for the drugs.

We shall see how far UnitedHealth will get with this oh so timid
experiment.


-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Adam Oliver
Sent: Wednesday, October 20, 2010 12:55 PM
To: [log in to unmask]
Subject: today's spotlight

SPOTLIGHT: A NEW WAY TO PAY
Health insurer UnitedHealthcare today is expected to release details of
a one-year pilot program to study a new payment method for cancer
treatments. The program aims to encourage physicians to follow standard
treatment regimens, instead of choosing individualized or unproven
tactics, which can include costly drug combinations. The program --
which currently involves five oncology practices in five states -- is
the first by a private insurer to examine "bundling" for cancer
treatment. Under the program, UHC will make a one-time payment for each
patient's complete course of cancer treatment for common cancers, and
physicians will receive a case management fee. The participating
practices will select the course of treatment for each patient. United's
move comes as the federal health reform law has further pressured
providers to scale back spending. However, critics contend the new
program is a step toward denying patients additional care or the latest
treatments, or rationing of care at the end of life.


Please access the attached hyperlink for an important electronic
communications disclaimer:
http://www.lse.ac.uk/collections/planningAndCorporatePolicy/legalandComp
lianceTeam/legal/disclaimer.htm

This e-mail, including attachments, may include confidential and/or
proprietary information, and may be used only by the person or entity
to which it is addressed. If the reader of this e-mail is not the intended
recipient or his or her authorized agent, the reader is hereby notified
that any dissemination, distribution or copying of this e-mail is
prohibited. If you have received this e-mail in error, please notify the
sender by replying to this message and delete this e-mail immediately.