HAP is a subsidiary of Detroit's Henry Ford Health System and has about 650,000 members in Michigan.
Historically, managed care has taken a hands-off approach to oncology services, explains John Calabria, MD, HAP's medical director. But with more than 900 new cancer drugs in the pipeline, it's time to be "proactive and assure our members that evidence-based treatment is being followed."
He notes that over-utilization of less effective drugs is a bad thing and so is under-utilization of effective drugs. "We want to help oncologists assure appropriate care."
The HAP program joins efforts by UnitedHealthcare, Humana, Florida Blue, and other payers, which have focused on bundled payments and accountable care organizations to stabilize revenue streams and payment structures in the emotionally charged cancer treatment arena.
For the first year, the HAP initiative will focus on breast, colon, and lung cancers. Calabria explains that according to national data, these are the cancers with the most drug expenditures and the most variation in patient treatment.