Improving Collaboration between Oncologists and Payers

Client:
Global pharmaceutical manufacturer with several physician-administered oncology products

Challenge:
Continued use of client’s products may be threatened as payers increasingly manage specialty products through the use of prior authorization, higher out-of-pocket costs, and reduced reimbursement levels. Without adequate reimbursement, prescribing physicians may not be able to continue administering client’s products.

Xcenda’s action:
Our market research specialists developed a unique program that allowed the manufacturer to play the role of mediator and open a dialogue between physicians and payers who shared common objectives: cost-effective treatment, equitable reimbursement, and superior patient care.

Find the right people
For the manufacturer’s program to be successful, Xcenda needed to gather feedback from key opinion leaders on both sides of the table. When targeting oncologists, Xcenda looked for physicians who would candidly discuss how clinical pathways could be improved within their own practices, as well as nationwide. On the payer side, Xcenda searched for decision makers at national or large regional payers who understood that more dialogue with providers would lead to more informed coverage decisions.

Xcenda proposed creating a national strategy council to include strategic thinkers, effective communicators, and collaborative advisors who could commit on a long-term basis to find solutions validated by data. As a result of Xcenda’s proprietary market research collaborations with oncologists and hematologists through the NOCR network and ION (International Oncology Network), and with payers through the Managed Care Network (MCN), Xcenda efficiently targeted and recruited advisors to participate on the council.  Participants included:

• Physicians from 18 large oncology practices, encompassing 200 total physicians and more than 250,000 patients
• Managed care executives from 18 payers that provide coverage for a combined 38.5 million Americans

Physician and payer participants provided feedback through live meetings and online surveys. The goal was to provide varied channels of interaction to let participants offer their thoughts frequently and organically. Xcenda’s market research specialists led all elements of the program to keep discussions on point and to ensure that the manufacturer stayed neutral to the process.

Create a shared vision of improvement
Physicians and payers who took part in the manufacturer’s program all recognized that the current system for cancer care and reimbursement is unsustainable. They shared concern over the rising cost of cancer treatment. They all pointed to decreasing variability in cancer treatment as a key priority. Still, a large challenge remained: the fundamental lack of trust between payers and physicians. Physicians felt that some payers made reimbursement decisions without adequate clinical knowledge. Payers felt that financial considerations motivated treatment decisions among some physicians.

To address this, program moderators from Xcenda’s market research team encouraged participants to create a shared vision and common action items. Words like “sustainable and measurable” combined with “patient-centric” and “aligned incentives” formed the strategy council’s vision. Action items focused on reducing variability of care and on education for all stakeholders.

Results: Put collaboration into action
Armed with these shared objectives, the strategy council participants then proposed pilot initiatives that would produce measurable results, including one that identifies clinical guideline adherence as a primary method for decreasing variability of care. In this pilot, a large oncology practice would focus on supportive care for patients with breast, lung, and colorectal cancers. Metrics would include clinical guideline adherence, reduced emergency room and hospital utilization, as well as patient satisfaction. Incentives from participating payers could include bonus payments based on a percentage of calculated savings or offering a differential fee schedule.

By leading the formation of the strategy council and facilitating a growing trust and collaboration between physicians and payers, the manufacturer affirmed its position as a thought-leader, an innovator, and an organization dedicated to improving cancer care. The strategy council demonstrates that a manufacturer can facilitate solutions that address the legitimate needs of all stakeholders.