Cardinal Health; P4 Healthcare, Dublin, OH; Blue Cross Blue Shield of Michigan, Detroit; Physician Resource Management, Novi, MI.
J Oncol Pract. 2012 May;8(3 Suppl):e38s-43s. doi: 10.1200/JOP.2012.000564.
Despite rising medical costs within the US health care system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of health care in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the health care cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology health care consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program.
尽管美国医疗体系中的医疗成本不断上升，但医疗质量和效果却没有得到改善。如果没有重大的政策改革，在可预见的未来，成本与质量之间的失衡将达到不可持续的程度。医疗保健成本的上升部分归因于人口老龄化的扩大，以及危及生命的疾病数量不断增加。这进一步加剧了越来越多的高成本疗法。在任何医学专业领域，这一点在肿瘤学领域表现得最为明显。为了降低成本，人们已经尝试了许多方法，但往往收效甚微，且持续时间短暂。由于医生直接或间接控制或影响着大部分医疗费用，因此必须改变医生的行为，才能以可持续的方式降低医疗成本曲线。学术界、卫生政策和商业领域的专家都认为，为了实现行为改变，利益相关者之间必须进行重大的范式转变合作。密歇根蓝十字蓝盾公司（Blue Cross Blue Shield of Michigan）和医师资源管理公司（Physician Resource Management）率先进行了这种合作，这是一家专门从事肿瘤学医疗保健咨询的公司，得到了 Cardinal Health 特种解决方案（Cardinal Health Specialty Solutions）的技术、分析和咨询支持，后者是 Cardinal Health 的一个部门。我们描述了支付方和医疗服务提供方之间在全州范围内的成功合作，以创建癌症临床护理路径项目。我们表明，利益相关者的激励措施一致可以推动高水平的提供者参与和遵守路径，从而改变医生的行为。此外，还可以收集、分析和使用基于索赔的数据来创建和维护这样的项目。
