title: Bending the cost curve: a unique collaboration between radiation oncologists and Blue Cross Blue Shield of Massachusetts to optimize the use of advanced technology.
abstract: OBJECTIVE
  Intensity-modulated radiation therapy (IMRT) limits the dose of radiation to critical normal tissue structures and can be applied to the management of most cancers treated with radiation therapy. Because of increased treatment planning time and quality assurance, IMRT is costly. Blue Cross Blue Shield of Massachusetts (BCBSMA) and the Massachusetts Radiation Oncology Physicians Advisory Council (PAC) developed a strategy to develop standards for the appropriate use of IMRT.
  
  
  METHODS
  Normal tissue volume guidelines were established in multiple oncology disease areas and body site regions. Guidelines were activated in September 2011, and the use of IMRT per case was tracked quarterly by BCBSMA staff.
  
  
  RESULTS
  During the first year of activation of the volume-based guidelines, use of IMRT decreased by 17% in Massachusetts, in contrast to a 20% increase during the previous year.
  
  
  CONCLUSIONS
  The normal tissue-based guidelines have decreased the use of IMRT in Massachusetts; increased the use of 3D treatment; continued communication between treating radiation oncologists and an insurance organization responsible for cost and quality in medicine; increased cost savings; enabled an efficient appeal process; and provided optimal, cost-effective patient care. This may prove to be an effective model for other disciplines and other developing and maturing radiation technologies.
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Lee
authors.initials: L
authors.lastname: Steingisser
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Brian
authors.initials: B
authors.lastname: Acker
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Berman
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Brenner
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Bornstein
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: Busse
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA Thomas.Fitzgerald@umassmed.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: FitzGerald
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Jacobson
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Eliot
authors.initials: E
authors.lastname: Jekowsky
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Mamon
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Andrea
authors.initials: A
authors.lastname: McKee
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Stevenson
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: David
authors.initials: D
authors.lastname: Wazer
authors.affiliation: Blue Cross Blue Shield of Massachusetts; Beth Israel Deaconess Medical Center; Massachusetts General Hospital-Harvard Medical School; Brigham and Women's Hospital and Dana-Farber Cancer Center; Boston Medical Center and Boston University School of Medicine; Tufts Medical Center, Boston; Baystate Medical Center, Springfield; St Vincent Hospital; University of Massachusetts Medical Center and University of Massachusetts Medical School, Worcester; Shields Health Care Group, Quincy; and Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: John A
authors.initials: JA
authors.lastname: Fallon
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans; D003299:Cooperative Behavior; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D008404:Massachusetts; D009369:Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D017063:Outcome Assessment, Health Care; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics* / Q000379:methods*; D012051:Reimbursement Mechanisms