Texas Oncology, Aetna Collaborate to Improve Patient Care Through Clinical Pathways


Texas Oncology and Aetna partnered to provide a practice-based program that reduced costs while maintaining adherence to treatment pathways and patient satisfaction in Medicare patients.

Cancer care delivery reform efforts are aimed at controlling costs while improving quality. Individuals from Texas Oncology and Aetna collaborated to conduct a payer-sponsored program that utilized evidence-based treatment pathways, a disease management call center, and an introduction to advance care planning to improve patient care and reduce total costs.

Led by J Russell Hoverman, MD, PhD, vice president of Quality Programs, Texas Oncology, and medical director of Managed Care, US Oncology Network, researchers enrolled 746 Medicare Advantage patients with nine common cancer diagnoses from June 2013 to May 2016 in the program. Oncology nurses telephoned the patients elected for support services in order to assess symptoms and quality of life as well as to introduce advance care planning.

Shared cost savings were determined by comparing the costs of drugs, hospitalizations, and ER use for 509 patients in the study group, matched with a cohort of 900 Medicare Advantage patients treated outside of the Texas Oncology network. Physician adherence to treatment pathways and quality metrics were evaluated.

Results of the program were published in the Journal of Oncology Practice (online March 16, 2018; doi:10.1200/JOP.17.00091).

Over the course of 3 years, the cumulative cost savings were $3,033,248. Researchers noted that savings continued to increase in each year.

After adjusting for age, diagnosis, and study year, drug cost savings per patient per treatment month were reportedly $1874 (95% CI, $1373 to $2376; P < .001). Researchers acknowledged that solid tumors contributed to most of the savings, while hematologic malignancies showed little savings.


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Additionally, Dr Hoverman and colleagues reported that for years 1, 2, and 3, adherence to treatment pathways was 81%, 84%, and 90%. Patient satisfaction with support services was 94%, 93%, and 94%, and hospice enrollment was 55%, 57%, and 64%, respectively.

Results of the program led researchers to conclude that “A practice-based program supported by a payer sponsor can reduce costs while maintaining high adherence to treatment pathways and patient satisfaction in older patients.”—Zachary Bessette