While many insurers already send physicians such reports on other areas of care, cancer reports have been “a third rail” because they might be perceived as a denial of coverage, Lee Newcomer, MD, senior vice president of oncology at UnitedHealthcare, said in the report.
UnitedHealthcare decided to send the reports on breast, lung and colorectal cancer because cancer is the insurer’s third most expensive disease area, costing $2.5 billion a year, after cardiovascular disease and orthopedic joint procedures.
Dr. Newcomer hopes that by pointing out to physicians how their treatments deviate from widely accepted standards, UnitedHealthcare could reduce unnecessary care. Critics say it is inappropriate for an insurer to monitor quality when it has a financial interest in the outcome.
UnitedHealthcare reported physicians’ noncompliance rates for the following cancer protocols:
- 17 percent noncompliance — Patients with a genetic market indicating a favorable response to the drug Herceptin should receive that drug (breast cancer).
- 61 percent noncompliance — Patients should receive ultrasound prior to treatment in order to determine how far the tumor has spread and to plan for treatment (colon cancer).
- 31 percent noncompliance — Patients with early-stage colon cancer should receive chemotherapy or radiation after surgery.
- 31 percent noncompliance — Patients should receive pulmonary function testing before treatment (lung cancer).
Read the Wall Street Journal’s report on UnitedHealthcare’s report to cancer physicians.
