To date, approximately 50 patients are enrolled in the three-year bundled payment pilot program, and “so far the data look very good,” said Randal S. Weber, MD, professor and chair of MD Anderson’s department of head and neck surgery. “For example, in our major surgical cases with reconstruction, our average length of stay [LOS] is just shy of eight days. That’s well below the national norm of around 10 to 13 days. So already, we are beginning to show that we can deliver highly efficient and effective head and neck cancer care with a lower rate of complications, as shown in the reduced LOS numbers.”
Explore this issue:November 2015
The pricing component of the bundled care model at MD Anderson also looks very promising, Dr. Weber stressed, adding that the center negotiated pricing for eight head and neck cancer bundles based on decades of research and clinical experience. “We did our homework,” he said. “We spent a great deal of time analyzing our costs for these procedures, and we set a price point for the bundles accordingly—one that we are very comfortable with. And so is UHC; this was a negotiated process. We know we’re not going to take a haircut, and UHC knows they’re not overpaying for the high-quality services we are providing to their covered patients.”
Dr. Weber said he had some initial concern that switching to a bundled care model might interfere with the many clinical research trials underway at MD Anderson. But in actuality, “UHC has been visionary in this regard,” he said. “They understand that large centers have to conduct clinical research. So if we have an approved protocol and it is deemed to be accepted cancer care, they’ll allow those patients to be on the bundle.”
Why is being research-friendly such an important part of the bundled payment pilot? “It’s the clinical trials that ultimately change guidelines-based therapy,” Dr. Weber stressed. “That flexibility is a huge win-win for us and our patients.”
As for next steps, Dr. Weber said that an expanded bundled payment model could be used “to economically profile an individual physician or treatment team that is risk-adjusted based on their patient population,” he said. “Your patients may be sicker than my patients, but with risk adjustment we can remove that degree of variability by factoring it into the value equation.”
Adjusting for risk, negotiating prices, partnering with payors—is this really in the comfort zone of most physicians? “It has to be, at least for some of us,” Dr. Weber said, “because that $200 billion price tag for cancer care in this country is simply not sustainable,” and keeping the traditional fee-for-service model is a prescription for reaching that dubious goal, he noted.