Our discussion today involves managing oncology treatment in a physician's setting. We are discussing the misalignment of physicians and the third party payers. Is it possible to align the goals of the physician and the payer?
Revera Health believes in creating "win-win" situations. This is possible when the health plan or employer creates an environment that rewards physicians for positive behavior and aligns incentives. How is this accomplished? The payer would utilize Revera Health to implement a comprehensive program around oncology. Revera Health would setup a model that would allow the physician to receive reimbursement for his entire drug cost - but not profit. The physician would receive payment for services provided including; administration, clinical oversight, and evaluation & management of the patient. The physician would also be rewarded for participating in the ongoing development of treatment protocols based on evidence-based medicine.
In this model, the physician becomes a partner in care and not a fee-for-service provider. The physician should receive incentives to provide ongoing education on the patients disease state, treatment options, diet, and end-of-life care planning.
The area of oncology is costly for payers - but it can be managed effectively. Medications in the biotech pipeline will be costly - many exceeding 100-200K per year/per patient. Some analyst estimate that the 1 million/per year drug is not far away. Just managing the cost of the drug won't prevent future problems for payers. Payers will need a partner like Revera Health to implement a new system of medical & pharmacy benefit management.
Revera Health believes in creating "win-win" situations. This is possible when the health plan or employer creates an environment that rewards physicians for positive behavior and aligns incentives. How is this accomplished? The payer would utilize Revera Health to implement a comprehensive program around oncology. Revera Health would setup a model that would allow the physician to receive reimbursement for his entire drug cost - but not profit. The physician would receive payment for services provided including; administration, clinical oversight, and evaluation & management of the patient. The physician would also be rewarded for participating in the ongoing development of treatment protocols based on evidence-based medicine.
In this model, the physician becomes a partner in care and not a fee-for-service provider. The physician should receive incentives to provide ongoing education on the patients disease state, treatment options, diet, and end-of-life care planning.
The area of oncology is costly for payers - but it can be managed effectively. Medications in the biotech pipeline will be costly - many exceeding 100-200K per year/per patient. Some analyst estimate that the 1 million/per year drug is not far away. Just managing the cost of the drug won't prevent future problems for payers. Payers will need a partner like Revera Health to implement a new system of medical & pharmacy benefit management.
