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Midstate health care organizations collaborate on cancer care

A Harrisburg-based health system is partnering with a local payer to reform breast cancer treatment in the midstate.

PinnacleHealth System and Highmark announced this week that PinnacleHealth is joining the Highmark Cancer Collaborative, which marks the first time that a midstate health system has joined the collaborative.

The collaborative was launched in March by Highmark and the Allegheny Health Network Cancer Institute in western Pennsylvania.

It reimburses participating providers through a new payment model when they are treating breast cancer with outpatient radiation.

Basically, oncologists will be reimbursed for performing what they deem most appropriate for each patient’s care, without needing preapproval from the insurance company.

Collaborative designed to ease cancer care

At PinnacleHealth, this new payment model will only apply when providers are treating people who are enrolled in Highmark’s commercial health plan, with employer coverage in Highmark’s Radiation Oncology Management Program.

Highmark’s Radiation Oncology Management Program establishes a single payment for patients with breast cancer who need radiation therapy as treatment. By removing administrative processes, such as prior authorization, treatment happens faster.

Traditionally, providers would have to receive authorization from the payer before treating breast cancer with radiation therapy.

The collaborative is designed to make cancer care easier for both the provider and the patient, because it eliminates prior authorization for radiation therapy treatment of breast cancer at PinnacleHealth facilities.

The goal of the collaboration is to help physicians find the most advanced medical science, and be able to offer this cancer care to patients without treatment being delayed.

“Nationally, cancer care can be fragmented due to its complexity, and our collaborative is working to address that issue,” said Dr. Virginia Calega, vice president of strategic clinical solutions at Highmark.

Lenay Ruhl

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