Health Plan Program

Practices that participate in ASCO’s Quality Oncology Practice Initiative (QOPI®) demonstrate commitment to self-assessment and quality improvement and those who go on to become QOPI Certified demonstrate that they deliver high quality care in alignment with the QOPI Certification standards.  A number of health plans recognize practice participation and achievement of QOPI Certification in a variety of ways, including special designation in physician directories or financial incentives for participating.

In an effort to recognize QOPI participation/Certification and reduce redundancy of quality assessment and reporting, ASCO continues to offer the Health Plan Program in collaboration with health plans nationwide.

Through this voluntary, optional program, QOPI participants and QOPI Certified practices can request that ASCO send verification of QOPI participation and/or achievement of QOPI Certification to applicable health plans that participate in the program.

Health Plan Program Accordions

Participating Health Plans

Health plans currently participating or that have participated in the past include the following:

  • Advocate Physician Partners
  • Aetna
  • Anthem Blue Cross and Blue Shield (CO, CT, KY, IN, ME, MO, NH, NV, OH, VA, WI)
  • Blue Cross Blue Shield Association**
  • Blue Cross of California; BC Life & Health Insurance Company (California)
  • Blue Cross and Blue Shield of Georgia, Inc.; Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (Georgia)
  • Blue Cross Blue Shield of Michigan
  • Empire BlueCross BlueShield (New York)
  • Health Alliance Plan
  • HMO Colorado and HMO Nevada
  • Humana
  • UNICARE Life and Health Insurance Company
  • UnitedHealthcare

**Blue Cross and Blue Shield

Blue Cross and Blue Shield Association and its 39 independent Member Plans ( http://www.bcbs.com/shop-for-health-insurance/ ), through an agreement with ASCO, may recognize providers for their QOPI participation by displaying the QOPI designation seal in the BlueCard National Doctor and Hospital Finder website and on provider locator websites managed by individual Member Plans”. Member Plans having an independent agreement with ASCO may also be listed separately from BCBSA and may receive participation information separately.

Only health plans with formal agreements in place at the time of reporting following  each collection round receive reports from ASCO through the Health Plan Program. 

For Participants

How To Participate: 

  • Participating and QOPI Certified practices can opt into the QOPI Health Plan Program at any time.
  • In the opt-in form, practices indicate whether they would like ASCO to send validation of participation and/or confirmation of QOPI participation and/or QOPI Certification to plans that participate and are selected by the practice.
  • Once a practice opts into the Health Plan Program, they remain active in the program until they opt out. 
  • ASCO provides reports to health plans after the close of each collection round.

Information Sent To Health Plans: 

The practice information transferred to health plans is limited to the following:

  • Practice: name, address, phone, taxpayer ID# or NPI.
  • Participating offices/sites: name, address, phone, taxpayer ID# or NPI, modules completed, total number of charts submitted, practicing oncologists/hematologists at each site.
  • Oncologist/Hematologist: name, NPI or UPIN

The opt-in form includes fields for practice personnel to enter all of the information listed above. Practice personnel should obtain appropriate permissions prior to opting into the QOPI Health Plan Program.

The primary focus of QOPI and the QOPI Health Plan Program remains practice-level. Physician-level data collection is not required to participate in the QOPI Health Plan Program; however, names of oncologists/hematologists in the practice will be collected on the opt-in form. Some health plans may put a ‘quality seal’ next to the physicians’ names in their provider directories, or otherwise recognize oncologists in participating practices.

The QOPI Health Plan Program will include the transfer of information about QOPI participation and QOPI Certification achieved only. ASCO will not send any information regarding your practice’s performance without your consent.

What You Can Expect: 

  • ASCO cannot dictate how plans recognize QOPI participation and/or QOPI Certification.
  • We encourage practice staff to discuss their QOPI Participation and QOPI Certification with the plans with which you contract.
  • ASCO continually assesses ways to expand QOPI and the QOPI Health Plan Program to best meet our members’ needs.

Engage Additional Health Plans to Join: 

ASCO welcomes additional health plans to the QOPI Health Plan Program. If there are plans you want to see included, please:

  • Provide relevant information on the designated section of the opt-in form, or
  • Ask plan representatives to contact us at qopi@asco.org, or
  • Send an email to qopi@asco.org with the relevant information (plan name and contact information)
For Health Plan Representatives

An Introduction: 

ASCO’s Quality Oncology Practice Initiative (QOPI®) is designed to promote excellence in cancer care by helping oncologists create a culture of self-examination and improvement.

  • More than 900 practices throughout the United States have enrolled in QOPI to obtain trusted and actionable information to assess and demonstrate quality oncology care, and to inform improvement efforts within their practice.
  • Staff at oncology practices abstract and submit data from patient records up to twice per year and receive reports that show their performance on established quality measures as compared to QOPI National aggregates. 

The QOPI Certification Program (QCPTM) launched in 2010 recognizes oncology practices that meet or exceed QOPI Certification standards. QCP seeks to promote the highest quality cancer care as defined by the clinician experts, and provide a uniform, rigorous, and proven solution for oncology quality efforts.  

  • QOPI Certification is based on performance on a subset of 26 QOPI measures selected for Certification, and the QOPI Certification Site Assessment, including structural measures of practice safety and quality.
  • Data and information submitted by all practices are audited before QOPI Certification is awarded.
  • Transparency is a key component of the QOPI Certification Program.  All aspects of the QOPI Certification Program are reviewed regularly by an expert Oversight Council, and are adjusted as needed to ensure the ongoing rigor of the program.
  • QOPI Certification Program Quality Measures: QOPI Certification evaluates 26 designated QOPI quality measures to determine practice eligibility to apply for Certification.
  • Scoring requirements for the QOPI Certification: Practices that choose to pursue QOPI Certification, must comply with QOPI chart selection methodology, meet chart target numbers for five categories of measures, and achieve an overall quality score of 75% or higher on the aggregated score across the 26 QOPI Certification designated measures.
  • QOPI Certification Standards: Practices must have policies and procedures in place to comply with the 20 standards related to safe chemotherapy administration.

QOPI and QOPI Certification can be integrated into payer Quality recognition programs in a variety of ways, to include, but not limited to acceptance of participation and Certification as quality assessment and improvement activities, use of thresholds or benchmarks to drive improvement and incentivize practices, as part of group collaborative improvement network initiatives, such as Blue Cross Blue Shield of Michigan has done with the Michigan Oncology Quality Consortium.

Recognizing QOPI Participation: 

  • ASCO is pleased to continue the QOPI Health Plan Program in collaboration with health plans Nationwide.
  • Through this voluntary program, QOPI participants can request that ASCO send verification of QOPI participation to health plans that participate in the program.

Recognizing QOPI Certification: 

  • As part of the Health Plan Program and with practice opt-in, ASCO will provide health plans with a practice’s QOPI Certification status.
  • This performance-based program provides a unique opportunity for outpatient hematology-oncology practices to demonstrate their quality achievements.
  • It also provides health plans an opportunity to utilize QOPI Certification status in quality programs and provide relevant information to patients, employers, and others.

Benefits to Health Plans: 

  • Improves Care: Both QOPI and the QOPI Certification Program promote practice improvement for all participants. Measures, scoring requirements, and structural standards are routinely reassessed to maintain rigor. 
  • Recognizes Quality: Participation in QOPI demonstrates a commitment to quality. Health plans can recognize practices that participate in QOPI or achieve QOPI Certification by highlighting them in physician finders or other plan materials.
  • Saves Time and Money: ASCO sponsors QOPI and QOPI Certification and as established National programs, and health plans can take advantage of these established programs to focus on quality with their providers.
  • ASCO Led: Health plans can rely on ASCO to take the lead on maintaining measures and standards, providing a means to assess them in the outpatient setting, and reporting practice-specific participation and Certification status information.
Questions Or Comments?

As always, please contact qopi@asco.org with any questions or comments.