Ira Klein, MD, MBA, FACP, Discusses Payer and ACO Oncology Care Pathways Participation

It is well known that oncology care pathways are the tools that practices can utilize to care for its patients. Ira Klein, MD, MBA, FACP, chief medical officer, National Accounts Clinical Sales & Strategy, Aetna, suggests that Aetna’s only involvement in creating these pathways should be in helping practices to develop “reasonable care pathways.” He adds that pathways should be measured and evaluated by quality outcomes, as well as by their possible financial outcomes. Dr Klein says that as a national payer, Aetna does not develop pathways because it believes they are “so dynamic” that it would rather let the experts be in control. He suggests that the insurer uses it as a part of its transactions instead.

Dr Klein continues, saying that cancer care management is difficult for accountable care organizations (ACO). This is because it not only consists of such a small portion of the population they treat, but because it is also low volume, high cost, and high variability. He explains that the ‘ACO World’ is about managing risk, and as a result, ACOs are afraid to manage patients with cancer because it conflicts with their actuarial model of risk management.

“What we are seeing are some ACOs looking either to beef up their cancer capabilities within the system — or if they have no cancer care capabilities or very limited cancer care capabilities — find external partners who are within their population and geographic locale, and set up relationships with those entities that can help them manage cancer,” says Dr Klein.