Outcomes With a Payer-Sponsored Medicare Advantage Cancer Management Program


Key Points

  • The program resulted in cumulative savings of > $3 million over 3 years.
  • Patient satisfaction with support services was high.

In a study reported in the Journal of Oncology Practice, Hoverman et al found that a Texas Oncology–Aetna Medicare Advantage collaboration resulted in cost savings, good adherence to treatment pathways, and high patient satisfaction over 3 years.

Study Details

The collaborative payer-sponsored program employed evidence-based treatment pathways, a disease management call center, and an introduction to advance care planning. Medicare Advantage patients with nine common cancer diagnoses were enrolled between June 2013 and May 2016. Breast cancer was the most common diagnosis.

Patients electing to receive support services were telephoned by oncology nurses who assessed symptoms and quality of life and introduced advance care planning. Shared cost savings were assessed by comparing costs of drugs, hospitalization, and emergency room use for 509 eligible patients in the study group vs a matched cohort of 900 Medicare Advantage patients treated by non–Texas Oncology providers. 

Primary Outcomes

Drug, inpatient, and emergency room expenses represented 71.7%, 25.8%, and 2.5% of total measured costs. During the 3 years of the study, the cumulative cost savings in the study group vs control group totaled $3,033,248, with savings increasing each year. Cumulative drug cost savings amounted to $2,622,760; drug cost savings per patient per treatment month totaled $1,874 after adjustment for age, diagnosis, and study year. Cumulative inpatient savings came to $385,752 in the study group.

Most of the savings were realized in treatment for solid tumors, with little savings observed in the treatment of hematologic cancers. The study group had a cumulative 3.5% reduction in emergency room costs. In years 1, 2, and 3, rates of adherence to treatment pathways were 81%, 84%, and 90%; rates of patient satisfaction with support services were 94%, 93%, and 94%; and hospice enrollment rates were 55%, 57%, and 64%.

The investigators concluded, “A practice-based program supported by a payer sponsor can reduce costs while maintaining high adherence to treatment pathways and patient satisfaction in older patients.”

J. Russell Hoverman, MD, PhD, of Texas Oncology, Dallas, is the corresponding author for the Journal of Oncology Practice article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.