CareCore National and D3 partner to accelerate implementation of cancer care pathways

To improve quality and contain rising costs in cancer care, CareCore National and D3, an affiliate of UPMC, have formed a new company to accelerate implementation of cancer care pathways.

“Partnering with CareCore increases our ability to bring payers and providers to the table to work together on a new model for improving the quality and value of cancer care.”

PathForward Oncology, the new company, will offer cancer care pathways developed at UPMC to health insurers and their oncology networks nationwide. Pathways are evidence-based clinical algorithms that standardize best practices for chemotherapy-based treatment and related services.

CareCore, one of the nation's leading specialty benefits management companies with proven care-management systems expertise, will enable oncologists to access the pathways at the point of patient care via an online care management platform. This software delivers pathways decision support to the physician's desk and opens the door to fully integrated digital data exchange, enabling the physician to consider available clinical and cost information when making care decisions.

"With the experience and expertise that CareCore brings through its 15-year history of working with health insurers, we expect to greatly enhance the scope and speed of implementing the cancer care pathways," said Kathy Lokay, senior vice president of commercial oncology services at UPMC and president of D3, a for-profit company in which UPMC holds a minority interest. "Partnering with CareCore increases our ability to bring payers and providers to the table to work together on a new model for improving the quality and value of cancer care."

"Cancer care requires a different approach to cost and quality management than the models typically used in health care. The path to continuing quality improvement and sustainable cost control in cancer care is to change the patient care process at the point of care," said Richard Weininger, M.D., medical director for oncology services at CareCore. "UPMC's pathways have been proven to reduce unwarranted variability in care at UPMC Cancer Centers and the other oncology groups that have adopted them. They fit perfectly with the CareCore approach to evaluating, supporting and managing episodes of care as distinct from individual services."

UPMC's cancer care pathways were developed over the past five years by UPMC and are regularly updated by oncologists who have adopted them in Pennsylvania, Texas, Florida and New Jersey. Sixteen disease-specific committees of academic and community-based physicians review and update the pathways on a quarterly basis, based on their evaluation of the latest clinical literature. Through this effort, a single, best treatment is identified for approximately 80 percent of patient presentations. These treatments are based upon reviewing the research first for the most effective, then the least toxic and, finally, all other factors being equal, the most cost-effective option.

"By standardizing care and driving to the best, evidence-based treatments, we've been able to demonstrate not only better care, but also a reduction in the total cost of care compared to practices without the pathways," noted Peter Ellis, M.D., medical director for the UPMC pathways program and a practicing medical oncologist at UPMC Cancer Centers.

PathForward Oncology is expected to begin operations in the first quarter of 2011.