Anthem Oncology P4P Program Boosted Evidence-Based Care

A recent study of Anthem’s Cancer Care Quality Program (CCQP) treatment pathways found that an enhanced reimbursement to providers who adhere to on-pathway treatment regimens increased use of the drugs without changing the total care spending, supporting the payer’s efforts to move the needle on value-based care. That program has since led to the insurer’s launch of an oncology medical home this summer.

Anthem launched CCQP in 2014, rolling it out to 14 states through the next year (RSP 6/14, p. 3). Administered by the plan’s AIM Specialty Health subsidiary, the voluntary program provides enhanced reimbursement of $350 for a person’s initial on-pathway treatment and then $350 every month after for a maximum number of months as specified by CCQP. Those payments are in addition to reimbursement for office visits and drugs. There’s no penalty if a provider chooses an off-pathway regimen.

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy (formerly called Specialty Pharmacy News) since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at HemAware (a hemophilia publication), Lupus Living and Momentum (a multiple sclerosis publication). She has a B.A. in English and an M.A. in British literature from Arizona State University.

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