Everyone just assumed that if the evidence were there, doctors would follow it. Not so. It was an instructional point in that we got to see how our data collection could have a positive effect on clinical practice.
— Lee N. Newcomer, MD, MHA
“I’m a Nebraskan,” said Lee N. Newcomer, MD, MHA, a leader in the oncology community who is well known for his innovative efforts to align physician payment and quality of care in ways that will best configure to the rapidly changing health-care environment. Speaking in the flat vowels and neutral accent of his home state, Dr. Newcomer—with typical Midwestern directness—condensed his notable career into one word: change.
“I came from small-town U.S.A. By the time I got to school, everyone in town knew what I had for breakfast,” said Dr. Newcomer. “After graduating from Nebraska Wesleyan University, a small liberal arts college, in 1974, I marched up the interstate to Omaha and entered the University of Nebraska Medical School, which was just emerging as a major cancer center,” said Dr. Newcomer. “One of the young Fellows who had gone off to Iowa for his hem/onc training was invited back to the Nebraska Medical Center as a professor. He was a Nebraskan, too, by the name of Jim Armitage. He was clearly a mentor for a number of us, sparking our interest in oncology,” he added.
“Another classmate was ASCO Past President Margaret Tempero. She was a year behind me but we had many rotations together. Jim Commers, another ASCO member, and I had our very first rotations as interns on the oncology ward, and I found two things that I loved about oncology. It was the late 1970s and the field was exploding with exciting scientific information and important new drugs. The other thing was how intimately I got to know the cancer patients and their families,” said Dr. Newcomer.
When he was in medical school, Nebraska was committed to recruiting family practitioners to serve the rural communities in the vast state. “In oncology you had all of the knowledge of the family that the community primary care doctor has, but you also got to practice in a highly detailed specialty, so it was the best of both worlds,” noted Dr. Newcomer. During the first 2 months of his internship, Dr. Newcomer also cared for his cousin’s husband, who later died of Hodgkin disease. That experience, coupled with his work on the cancer ward, cemented his desire to pursue a career in oncology.
From Private Practice to Managed Care
Following his residency, Dr. Newcomer completed a fellowship in medical oncology at Yale University in 1981. “I spent 1 year in Minneapolis, practicing at the Park Nicollet Clinic, which is a multispecialty institution. There were about 250 doctors there at the time and it gave me an early experience in both managed care and group practice, which I liked a lot,” said Dr. Newcomer.
He continued, “But unfortunately, Minnesota is so cold that it’s uninhabitable, at least for me [at that time]. So I joined five other doctors in Tulsa, Oklahoma. They all came from heavy academic programs, and it was the best of both worlds in that our practice was a major contributor to ECOG clinical trials. At the time I joined the private practice we were actually ECOG’s second largest patient contributor,” said Dr. Newcomer.
“We were a hospital-based practice. William Warren, who owned the oil company that eventually became Gulf Oil, had a daughter with breast cancer. There was no one in Tulsa to care for her so he built a cancer center within the hospital and recruited us. However, we came to believe that a free-standing cancer center of our own would make better business sense and would be able to serve patients more efficiently,” said Dr. Newcomer. He and his associates eventually set up a freestanding clinic, and Dr. Newcomer was the managing partner for the transition.
It was during that experience when Dr. Newcomer’s commercial interest blossomed, but he also realized that he didn’t know enough about business. “I went back and got a masters of health administration degree at the University of Wisconsin. And then I went into managed care. It was a pivotal career move,” said Dr. Newcomer.
New Beginnings at UnitedHealthcare
Dr. Newcomer took a position as Medical Director of CIGNA Health Care of Kansas City. “I was there about 8 months when a headhunter called about a position at UnitedHealthcare. To tell the truth, I’d never heard of UnitedHealthcare,” he admitted, but was convinced to go to Minneapolis and interview for the position. He got the job.
“When I was hired, United was just starting a health services department. I took the lead building the medical department. At that time we had less than a million members covered over 16 sites with no full-time medical directors. We now serve about 70 million individuals nationwide, so it’s been a remarkable growth,” said Dr. Newcomer.
Dr. Newcomer commended UnitedHealthcare’s forward-looking style, one that encouraged creative thinking. “Someone in the company had the vision to make our system one that’s capable of reporting data in addition to just paying claims. So, from day 1 we started looking at claims data to analyze how medicine was being practiced,” said Dr. Newcomer.
One of the company’s first efforts was seeing if heart attack patients were given beta-blockers. “Even though there were 24 studies saying that these patients benefited from beta-blockers, only 30% of our heart attack patients were receiving them. We pointed this out to the American College of Cardiology. They were shocked at our data. Everyone just assumed that if the evidence were there, doctors would follow it. Not so. It was an instructional point in that we got to see how our data collection could have a positive effect on clinical practice,” said Dr. Newcomer.
A Specialized Oncology Division
Dr. Newcomer left UnitedHealthcare in 2001, feeling stifled by the mounting organizational activity needed to keep pace with the company’s expansion. “Managing the nuts and bolts of a company growing at that pace didn’t mesh with my entrepreneurial aspirations. I put together a startup business with several friends. I did that for about 5 years, and then I got a call from UnitedHealthcare. They invited me back to take a look at starting a cancer-specific team at UnitedHealthcare,” said Dr. Newcomer.
“I agreed, as long as I could focus on how we could deliver better, more affordable cancer care. In essence, they gave me what I’ll call ‘an extra room in the closet.’ We had a small staff of about 10 people, but we had a hall pass to go to any department in UnitedHealthcare and work with them to change the way they supported cancer care. It was a perfect way for me to explore exciting innovations backed by a very large company. On a professional level, it was the equivalent of heaven,” said Dr. Newcomer.
Reforming the Oncology Payment Model
On Dr. Newcomer’s second day as head of UnitedHealthcare’s newly formed oncology division he had a rude awakening. “I was at a national cancer practice managers meeting. At least 25 speakers got up and said what a terrible job UnitedHealthcare was doing in cancer claims payment. In response, we developed a specialized cancer claims payment unit,” said Dr. Newcomer.
Since the new unit was established, UnitedHealthcare’s physician satisfaction rate has gone from 60% to 93%, and its ranking in oncology has consistently occupied the number 1 slot. “We’re now able to focus our programs on things that make sense for oncology. In the past, a general medical director reviewed all conditions. Our new focused approach makes a lot more sense, especially in such a complex specialty like oncology,” said Dr. Newcomer.
The buy-and-bill system in medical oncology is arguably one of the most difficult issues facing cancer care. The debate rests on how to replace the oncology payment system with one that adequately reimburses oncologists for the intricate and valuable services they provide.
Led by Dr. Newcomer, UnitedHealthcare has spearheaded a pilot program to test a bundled payment model for oncologists. The program pays a flat fee that factors in what the physicians would have made by charging the health plan a margin on the chemotherapy drugs provided to the patient. “It’s a much more collaborative process than the old model, and it’s a lot harder than any of us ever appreciated, ” said Dr. Newcomer, in his typical straightforward manner.
He’s a Nebraskan, after all. ■