© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 6, 480,
March 21, 2001
© 2001 Oxford University Press
CORRESPONDENCE |
More About: Improving the Cost-Effectiveness of Colorectal Cancer Screening
Correspondence to: Alan M. Muney, M.D., M.H.A., Chief Medical Officer, Oxford Health Plans, 48 Monroe Turnpike, Trumbull, CT 06611 (e-mail: Amuney{at}oxhp.com).
In reaction to the editorial by Atkin and Whynes (1) regarding cost-effectiveness of colorectal cancer screening, screening guidelines published and promoted by health plans are consensus guidelines based on the relevant sources in the industry. It is natural for guidelines to change over time as new information and studies come forward. What health plans do not do is look at how long a time frame exists until net cost savings occur. Health plans recognize that the services we pay for today may benefit another health plan 20 years from now instead of the member's current health plan, and obviously the opposite is true as well. It is clearly in society's long-term interest in terms of lowered long-term costs for health plans not only to cover near-term screening expenses but also to promote utilization in these areas. The same cost–benefit argument exists for the many disease management programs whose return on investment may benefit the next health plan the member enrolls in rather than the health plan that paid for most of the case management that allowed improvement for that individual patient. Many health plans have excellent evidence that medical costs have decreased for those disease-managed members who have been continuously enrolled over several years.
Health plans currently compete on effectiveness of care-quality measures, such as mammography screening. Large employer groups currently use these performance measures as one tool on a menu of factors by which they choose a health plan. Therefore, a health plan that does not promote screening in the short term has a very real sales and marketing problem as employers increasingly use screening performance as a measure of the value they expect to get from their health plan.
Lastly, since screening guidelines are often debated in the literature, health plans acknowledge that a single guideline may not fit all members. The guidelines of the Oxford Health Plans do comply with those of the American Academy of Family Physicians that suggest that patients older than 50 years receive a screening sigmoidoscopy, to be repeated every 3–5 years. However, these guidelines are changing so that individual doctors may perform a colonoscopy or a sigmoidoscopy as they deem appropriate for that individual. Again, the notion that a health plan or an individual doctor would choose a specific screening in this case based on what one procedure's long-term net savings is compared with another's long-term savings simply does not enter into the equation when the patient needs screening. The individual physician's job is to choose the procedure based on the current best evidence for that patient, and the health plan's responsibility is to cover decisions based on current best evidence.
REFERENCE
1
Atkin WS, Whynes DK. Improving the cost-effectiveness of colorectal cancer screening [editorial]. J Natl Cancer Inst 2000;92:513–4.
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