How insurers can speed up adoption of evidence-based care

New drugs offering a cure for hepatitis C patients hit the market a few years ago with jaw-dropping price tags. A 12-week course of treatment could eliminate the deadly liver infection, but at a cost of nearly $100,000.

So Danville, Pa.-based Geisinger Health Plan sought to ensure it would get the most bang for its buck by eliminating variation in treatment and improving the quality of care.

The health plan reached out to Geisinger clinicians to come up with a standardized process for treating hepatitis C. Taking a bottom-up approach, it asked care teams of physicians, nurses and pharmacists and others to determine best practices, including which drugs work best for which patients, what lab tests are needed, and how often does a physician need to follow up?

Together the health plan and providers came up with a clinical pathway that led to a hepatitis C cure rate of 97.5% among Geisinger patients. Instead of a hepatitis C patient visiting a hepatologist up to five times during a course of treatment, the new pathway called for ongoing patient care to be managed by a multidisciplinary team via telephone and online web portal, which freed up the specialists.

And by monitoring national literature and tracking its own data, which were shared with all care team members, Geisinger determined that it could cure hepatitis C with an eight-week course of treatment for certain patients, instead of a 12-week course, saving tens of thousands of dollars. Working with the care teams helped Geisinger Heath Plan generate clinical support for creating and improving its hepatitis C treatment protocol.

The process was "fundamentally different than a health plan coming up with a prior authorization process and saying: We're going to slap your hand if you do the wrong thing, and here's what we consider the right thing to do," said John Bulger, a doctor of osteopathic medicine who is the chief medical officer at Geisinger Health Plan. "There's a certain amount of autonomy and a certain amount of ownership and shared purpose that you create when you do it the way we've done it as opposed to a top-down approach."

A shared consensus and commitment to changing how care is delivered is one element to creating strong payer-provider partnerships that can ultimately speed up the adoption of evidence-based care, according to research released Wednesday by the Alliance of Community Health Plans, whose members are not-for-profit provider-based health plans that include Geisinger.

The alliance's report revealed five best practices for health plans who want to influence and support physicians in bringing the latest evidence-based care to the exam room. Citing the Institute of Medicine's 2001 report Crossing the Quality Chasm, the alliance noted that it takes an average 17 years for a medical breakthrough to reach the point of care.

"As much as we hail the amazing discoveries here and around the globe, it's taking that long to actually help treat and cure patients," said Ceci Connolly, president and CEO of the alliance. "So we were particularly interested in that notion of getting the evidence-based care, the data, the information, the education, the strategies, in the hands of physicians and getting them to act on that information much more rapidly."

Beyond creating a shared commitment to change, the alliance's best practices for health plans include creating multidisciplinary teams from the health plan and delivery system to tackle tough issues; tailoring how information is disseminated to clinicians; sharing timely data and feedback to promote competition and hold clinicians accountable; and aligning financial incentives with other best practices to influence behavior.

Health plans can play a key role in supporting clinicians with collecting and learning from data, but it takes real collaboration to put the data to use. Instead of sending outcomes data to clinicians, the health plans that were studied visited with physicians to explain the data and compare the medical practice's outcomes with the national average, Connolly said.

From there, health plans can play a valuable role in educating care teams about best practices and tailoring that information "to make it easy for the doctors to do the right thing," she said. They can also help assemble care teams around certain initiatives.

The best practices outlined in the report aren't limited to provider-sponsored plans; the study also includes traditional health plans, such as Buffalo, N.Y.-based Independent Health, that have built close partnerships with providers over a number of years.