CIGNA, Great-West Focus on DM
- - November 25th 2011
Cancer DM programs are another strategy for helping to improve care and reduce costs for oncology patients. CIGNA expanded an existing specialized case management program to create its new oncology condition management program. The old program was focused primarily on "high-acuity patients with cancer who are in active treatment or immediately post-treatment," says David Ferriss, M.D., national medical director of clinical program development for CIGNA HealthCare. "It has very much a specialty case management orientation and focus." The new version takes a "very population-based approach to the whole spectrum of oncology," and includes elements of case management and DM, Ferriss says. It includes the specialized case management elements, "but really expands it across a much broader scope in terms of early detection and prevention," as well as surveillance of enrollees who now are in remission, he explains. The program was developed partly in response to employers that were pushing for a more comprehensive program, he adds. Ferriss says that CIGNA is integrating the oncology management program with its existing specialty pharmacy efforts targeting oncology agents. CIGNA manages specialty pharmacy distribution services through its home delivery pharmacy subsidiary, CIGNA Tel-Drug. The specialty pharmacy program works with physicians who order oncology drugs, while specialty oncology nurses in the condition management program will work with patients to help them manage medication issues, including side effects, Ferriss explains. The program becomes available on Jan. 1, 2007, and is open to all cancer diagnoses, with the exception of squamous cell skin cancers. Payment for the program will be on a per-employee, per-month basis, although CIGNA officials would not say how much the program will cost employers. Great-West Healthcare addresses oncology through a DM program provided by Matria Healthcare, Inc. subsidiary Quality Oncology, as well as through case, utilization and pharmacy management, says Lynne Higgins, the insurer's director of DM programs. The DM program has been in place since July 2003. The insurer outsources oncology pharmacy management to Quality Oncology as well, Higgins says. "Pharmacy is something that is so relevant to cancer management, with so many drugs out on the market," she explains. "There are so many different combinations of chemotherapy agents that can be given, [and so] we realized this was something that we as a carrier wouldn't be able to keep up with." The MCO also requires physicians to purchase some oncology agents directly from its specialty pharmacy, Express Scripts, Inc. subsidiary CuraScript Pharmacy, Inc., rather than allowing physicians to purchase the drugs themselves and bill the insurer, says Mike Norris, Great-West's assistant vice president of medical outreach. Great-West has two exclusions: squamous cell skin cancer and pediatric cancers, Higgins says.