WellPoint (an independent licensee of the Blue Cross and Blue Shield Association) has announced its policy holders will now be subject to a new protocol regarding cancer care in an effort to lower costs for those seeking treatment of cancer.

Their physicians will be paid a bonus of $350 dollars per month for each patient who is on one of the insurer’s recommended regimens.  In other words, patients are going to be treated according to the insurance carrier’s protocol.

Putting this in perspective, Brian J. Bolwell, chairman of the renowned Cleveland Clinic’s Taussig Cancer Institute said, “We generally don’t like to practice by insurance company, we practice by patient.”

WellPoint estimates that it will save around $216,000,000 million dollars.  The protocols will focus on breast, lung and colorectal cancer but will eventually expand to other forms of the disease.

Roy Herbst, a professor at Yale School of Medicine worries that the “broader push toward a narrower number of regimens might cut against emerging approaches that personalize treatment based on genetic factors.”

It is anticipated that Cigna and UnitedHealth will follow suit with the same protocols.  It is important to note that WellPoint expects its recommendations to apply to 80 to 90 percent of its patients.  What’s important to note here is that these protocols DO NOT apply to self-funded, partially self-funded or captive plans like the ones we offer to our clients.  

Cary Hall

America’s Healthcare Advocate