Implementation of cancer clinical care pathways: a successful model of collaboration between payers and providers
| Autor: | Jeffrey Scott, James Lang, Thomas Rybarczyk, James Grzegorczyk, Joseph Cooper, Phillip Stella, Thomas Leyden, Donna Stark, Scott Milligan, Bruce A. Feinberg, Thomas Ruane |
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| Rok vydání: | 2012 |
| Předmět: |
Michigan
Population ageing medicine.medical_specialty media_common.quotation_subject Original Contributions Specialty Medical Oncology Neoplasms Health care Humans Medicine Quality (business) Cooperative Behavior Health policy health care economics and organizations media_common Insurance Health Oncology (nursing) business.industry Health Policy Stakeholder Health Care Costs Public relations Models Economic Incentive surgical procedures operative Oncology Models Organizational Family medicine Critical Pathways Managed care business |
| Zdroj: | Journal of oncology practice. 8 |
| ISSN: | 1935-469X |
| Popis: | Despite rising medical costs within the US health care system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of health care in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the health care cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology health care consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program. |
| Databáze: | OpenAIRE |
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