Radiation Therapy Management Education Session

CareCore National to Present "Managing Radiation Oncology Quality and Reimbursement with Evidence-based Pathways" at the Blue Cross Blue Shield Association's Fall 2009 Distinctively Blue Conference

Bluffton, SC (September 10, 2009) – CareCore National, a leader in the management of high-cost and technically complex outpatient healthcare services with longstanding experience in managing oncology, will present “Managing Radiation Oncology Quality and Reimbursement with Evidence-based Pathways” at the Blue Cross Blus Shield Association's 2009 Fall Distinctively Blue Conference on October 5, 2009 in Atlanta, Georgia.  The session examines the current radiation therapy environment with its rapidly increasing utilization and cost, escalating claims adjudication complexity driven by divergent utilization patterns, and care variation in the treatment of cancer by focusing on the role of evidence-based clinical protocols used in quality and reimbursement management that result in marked impact on both quality and cost.

In 2009, more than 900,000 cancer patients will undergo radiation therapy in the U.S.  Oncology spending is projected to grow to over $55 billion.  The growth in the use of treatments such as intensity-modulated radiation therapy (IMRT), image guided radiation therapy (IGRT), Gamma Knife®, Cyber Knife® and the emergence of new technologies such as proton beam therapy and Rapid Arc® has provided more options to treat cancer.  As new and emerging technologies for radiation therapy provide more treatment options, concerns over managing these costs within appropriate clinical guidelines increase.

The costs associated with radiation oncology are rising faster than overall healthcare inflation. This rising trend has been most notable since 2000, at which time we saw a dramatic escalation in the use of new technologies, particularly intensity-modulated radiation therapy (IMRT) and associated techniques. Additionally, the emergence of even newer technologies such as proton beam therapy (PBT) promises to increase expenses several fold at least. Because the technologies and techniques of radiation therapy are both complicated and arcane, there has been little work done to analyze the various components of care and coding in radiation oncology, and inadequate attention has been paid to this specialty’s cost and quality of care.

“Managing Radiation Oncology Quality and Reimbursement with Evidence-based Pathways” examines how the application of evidence-based pathways in radiation oncology has the potential to produce a very marked improvement in the variation of practice that is apparent from the examination of medical claims.  Session objectives include:

• Scope of services provided in a radiation therapy treatment plan
• Miscoding potentials that can lead to excess expense and poor quality in the delivery of radiation therapy
• Analysis of claims data that can be used to define episodes of care in radiation oncology
• Application of expert clinical pathways to radiation oncology treatment plans
• Measurement of clinical and economic benefit that can be derived from the use of clinical pathways in radiation oncology

The session will be presented by CareCore National Executive Vice President of Oncology and Product Development Dr. Richard Weininger and Horizon Blue Cross Blue Shield of New Jersey Chief Medical Officer and Vice President Dr. Richard Popiel. “Managing Radiation Oncology Quality and Reimbursement with Evidence-based Pathways” will take place on Monday, October 5, 2009 at 3:45 PM at the Westin Peach Tree Plaza in Atlanta, Georgia. 

About CareCore National, LLC 
CareCore National is a specialty benefit management company that delivers innovative solutions that focus on managing high-cost healthcare segments such as diagnostic and cardiac imaging, cardiac implantable devices, oncology drugs and adjunctive therapies, radiation oncology, sleep disordered breathing, pain management and lab services including genomic testing.  Through our robust product offerings, CareCore National works with health plan clients to improve utilization and enhance quality.  Our expert staff of medical directors and nurses administers the dynamic clinical protocols and innovative approaches needed to deliver first-class specialty benefits management. CareCore National is URAC accredited in Health Utilization Management and certified by NCQA in Utilization Management. For more information, visit www.carecorenational.com.