Considering WellPoint's Decision to Cover CT Lung Screening

December 21, 2011

WellPoint’s decision earlier this month to cover CT scans for heavy smokers may encourage other insurers to follow suit, paving the way for imaging sites to set up screening programs. But, for now, payers and practices alike are waiting to see what happens next.

WellPoint’s decision earlier this month to cover CT scans for heavy smokers may encourage other insurers to follow suit, paving the way for imaging sites to set up screening programs.

But, for now, payers and practices alike seem to be waiting to see what happens next.

“I don’t think we have a lot of patients in our population covered by WellPoint, so everyone is waiting for whether this is the tip of the iceberg and to see if other companies step up,” said Jeffrey Mendel, MD, a radiology professor at Tufts Medical School and chief radiology advisory for nonprofit Partners in Health. He also does dose reduction and CT research with Philips Healthcare.

Mendel called WellPoint’s decision a “huge change,” as it is the first healthcare organization that reviewed the data and determined their patient population would benefit from CT scans for lung cancer screening. WellPoint, with about 34 million members, made the decision based on the results of a government-funded trial that found screening heavy smokers with low-dose helical CT lowered risk of lung-cancer deaths by 20 percent.

WellPoint will cover CT screening for people matching the characteristics of the trial sample, including that they smoked the equivalent of a pack a day for 30 years, are between 55 and 74 years old, and had no signs or symptoms of lung cancer before the trial.

WellPoint’s decision will provide the industry with a large cohort of patients and data that could be useful in supporting the research on CT’s effectiveness, Mendel noted. According to the Wall Street Journal, UnitedHealth Group, Cigna, and Aetna are considering the National Lung Screening Trial data, but that CT scans for lung cancer screening is still considered experimental. Aetna also indicated they are awaiting guidance from government agencies like the U.S. Preventive Services Task Force.

When the NLST results were released last summer, American Cancer Society chief medical officer Otis Brawley, MD, said the findings were important and would be considered as groups create recommendations for early detection. He noted that best practices for implementing lung cancer screening have yet to be defined, and implementation should be organized and deliberate. "Finally,” he stated, “if and when major groups do make a recommendation for screening, it will be important that those considering screening be made aware of the significant number of false positive findings and potential other harms associated with downstream testing that can occur with spiral CT scanning."

Until other payer make the same move, or organizations like the USPSTF advocate for screening programs, practices and hospitals likely won’t rush to set them up for their patients. Screening programs require some complex logistics and planning, Mendel said. And radiologists want to be able to offer the CT screening to all their patients, not a select few.

Mendel also said, as radiology departments begin to ponder such programs, they may want to consider technology to help manage the findings. Vendors have programs that calculate the volume of the nodule automatically, he said, which can help sites assess nodules. This will improve their throughput, he said. The tumor evaluation programs allow radiologists “to convert a great deal of slice data into a small amount of tabular data because it’s easier to follow up.”