The Highmark Cancer Collaborative recently announced that in its first year, participating medical oncologists and radiation oncologists achieved industry-leading results that positively impact Highmark members.

This success included 83-percent adherence with evidence-based, clinical pathways recommended by leading national cancer experts, centers, and specialty societies. And use of innovative “episode-of-care” payment models helped to incent value-based care over the volume of procedures performed. Published studies indicate 35-percent cost savings are associated with pathways adherence, along with higher care quality; safer, more effective treatment; and more cost-effective care.*

In addition, through collaboration with Johns Hopkins Kimmel Cancer Center, the Highmark Cancer Collaborative has facilitated expanded access to innovative clinical trials available to qualified patients in western Pennsylvania. For Highmark members in all coverage areas, the Collaborative also introduced second-opinion consults for rare and complex cancers with leading cancer researchers and increased the use of appropriate molecular testing to provide actionable data for use in enhancing treatment and providing a safer, more patient-friendly experience of care.

Success by the numbers

During the Highmark Cancer Collaborative’s inaugural year, 29 physician practices participated in its pathways program. Together they made over 2,000 treatment decisions using advanced decision-support tools, demonstrating how quickly best practices can be adopted.

Based on this success, the Highmark Cancer Collaborative is expanding its clinical pathways program to include guidelines on five additional cancers — myelodysplastic syndromes and kidney, bladder, esophageal, and gastric cancers. These five cancers were selected because data indicate their inclusion would greatly impact additional Highmark members.

The Collaborative now offers clinical pathways for 23 different cancer types, covering over 96 percent of cancers impacting Highmark members.

Greater collaboration with Johns Hopkins Medicine

As part of the expanded relationship with Johns Hopkins Medicine, Highmark is establishing a Preferred Referral Partnership, which entails:

• Highmark members in all our markets will have access on an in-network basis to Johns Hopkins for rare and complex adult and pediatric cancers and for lung and pediatric bone-marrow transplants.
• Highmark will offer a “Concierge” program committed to enhancing members’ access to Johns Hopkins when necessary.
• Both Highmark and John Hopkins Medicine will continue to collaborate on even greater value-based reimbursement plan designs for the benefit of employers and members alike. The organizations expect to have products in the market as early as 2019 and reward members for seeking care at Johns Hopkins and participating high-value providers in Highmark’s network.

The expanded partnership with Johns Hopkins will include greater sharing of knowledge and expertise by Allegheny Health Network (AHN) and Johns Hopkins physicians.

Patients referred to Johns Hopkins will gain the benefit of world-class expertise and innovation in their treatment plans that drive the best possible results. These include remote consultation and second opinions, peer-to-peer consultations, and access to new technology, such as proton beam therapy, a cutting-edge radiation treatment available at only a handful of centers nationwide.

AHN patients will also have access to hundreds of active and new clinical trials that will be conducted at both Johns Hopkins Medicine in Baltimore and at AHN in western Pennsylvania.

For more information about the Highmark Cancer Collaborative's recent successes, read this press release . And watch Provider News for updates on the progress that the Collaborative is making to improve cancer care.

*A national study published in the Journal of Oncology Practice found that patients following evidence-based clinical pathways for oncology treatments saw 35 percent lower costs versus patients receiving traditional treatment approaches.