Doctors catalysts for pay-for-performance program

A Washington state oncology group hopes its "clinical pathways" project can improve care, reduce insurer costs and boost the bottom line.

By Kevin B. O'Reilly, AMNews staff. Dec. 25, 2006.

If the physicians at a Washington state oncology group adhere to strict quality and efficiency guidelines, they could get a boost in pay from a local health insurer. It sounds like one of the hundreds of pay-for-performance programs sprouting up around the country, but here's the twist: It was the doctors' idea.

Bruce Cutter, MD, is an oncologist and president of Cancer Care Northwest in Spokane, Wash. In 2003, he approached a Premera Blue Cross regional medical director and said, "Can we have a different conversation about how things are done and what we are trying to accomplish?"

That conversation with Dave Johnson, MD, gave birth to a physician-led quality and cost measures program known as clinical pathways. The program is part of a larger Cancer Care Northwest quality effort for which Premera kicked in start-up money to help institute an electronic medical records system and expand the group's patient-support initiative.

"This was all done internally," Dr. Cutter said. "Premera had no right, nor did they ask for the right, to dictate anything. It's very much a physician-driven, clinically driven program."

For a year and a half, the 20-physician group worked to tweak guidelines from the American Society of Clinical Oncology and the National Comprehensive Cancer Network to help cut practice variation and insurer costs.

So far, Cancer Care Northwest has developed clinical pathways for lung, breast, colon and ovarian cancer, giving them "teeth," in Dr. Cutter's words, by measuring compliance and requiring doctors who want to deviate from the plan to get approval from a quality committee.