Delta Air Lines’ Approach to Patient Care: High-Performance Cancer Networks

November 2012, Vol 3, No 8

Houston, TX—Delta Air Lines has a commitment to preventive health and comprehensive cancer care for its 140,000 health plan members; the company is piloting a “high-performance cancer network,” said Lynn Zonakis, Managing Director of Health Strategy and Resources, Delta Air Lines, Atlanta, GA, at the 2012 Second Annual Conference of the Association for Value-Based Cancer Care. Ms Zonakis was part of the employers’ panel at the conference who presented perspectives from different employer groups related to cancer care.

Delta contracts with 1 national insurance carrier—UnitedHealth Group—for multiple plan design options for active employees, retirees aged <65 years, and their dependents.

Cancer care accounts for 16% of Delta’s overall health plan costs, 25% of high-cost expenses associated with claims, and 20% of its pharmacy spending. Among the various tumor types, breast cancer is the most costly.

A Business Perspective on Best Practices

Quality of care, economics, cost, and employee productivity are the key issues and concerns that make cancer management a top priority at Delta, Ms Zonakis said.

Elaborating on these issues, she noted that reducing variations in practice and pathology testing is important for high quality of care. With regard to cost, Delta is interested in monitoring trends, minimizing perverse incentives for providers (eg, reimbursement linked to drug use, use of futile therapy), and reducing off-label drug use.

Even from a business perspective, Ms Zonakis said, employee productivity suffers as patients or caregivers lose time from work, develop secondary depression, and have trouble navigating the medical system. Therefore, employers have a stake at providing employees access to the best care possible, including cancer care, at the lowest cost.

Delta’s Oncology Initiatives and Cancer Network

Oncology management “starts with prevention,” she said. “Long before the Affordable Care Act, we began paying 100% for all preventive services that are recommended by the US Preventive Services Task Force, and in many cases we go beyond the recommendations.”

Care given at a National Compre­hensive Cancer Network (NCCN) Center of Excellence is covered 100% after the deductible is met, and Delta pays for travel and lodging expenses as well. “The Centers of Excellence are an important program of ours. There are rare cancers that call for specialized expertise, and we want to remove access barriers for our members. We have some great success stories from employees who have taken advantage of this.”

Delta also has comprehensive care management and cancer-specific care management programs that are staffed by dedicated oncology nurses; em­ployee assistance and behavior health programs; and pharmacy benefit management strategies for oral agents, injectables, and infusions.

Ms Zonakis was most excited about cancer programs that are under way at Delta, especially the “high-performance cancer networks,” which are being piloted in communities where most cancer care is delivered. The goals of these programs are to:

  • Supplement the NCCN Centers of Excellence, by identifying quality providers at the local and regional levels
  • Collect practice and outcomes data and measure results
  • Establish pay-for-performance (PFP) standards to reward providers for reaching various evidence-based goals.

“We must start solving the problems of lack of performance data and practice variation at the local and community levels,” Ms Zonakis said, and these networks should help to do that.

Management Support

Delta’s cancer program will also include day 1 referrals into a cancer support program and access to NCCN patient resources. “We want the program to have early referral for case management support before the patient’s course is set,” Ms Zonakis pointed out.

The initial rollout is in Atlanta, GA, and Minneapolis-St Paul, MN. If the program proves robust enough, Delta may establish a closed network of preferred oncology providers, Ms Zonakis noted.

In addition, under way is a joint project of the National Business Group on Health and the NCCN that aims to identify ways to assist employers in cancer-related benefit design and to improve the second-opinion referral process.

Within this are efforts to enhance employee communications (to reinforce the importance of healthy behaviors and early detection and to offer tools to manage cancer care) encourage appropriate palliative treatment and use of hospice, and to use onsite primary care for prevention and early detection of cancer.

Pay-for-Performance Program in Oncology

To participate in the PFP oncology program, providers must agree to be measured and evaluated, and they must strive to practice the best evidence-based medicine. The NCCN guidelines and compendium will be used, but the aim is to further refine these guidelines and encourage physicians to “hone in on what works best,” she added.

A portion of physician reimbursement will be linked to evidence-based goals, and these goals will be revised annually. The initial focus is on overtreatment of bony metastasis and overuse of radiotherapy in patients with breast cancer, Ms Zonakis said.

Related Articles