The following article is the fifth in a five-part series on The Top Five Ways for Health Plans to Manage Oncology Drug Costs While Improving Member Treatment Options.
Evaluating cancer treatment options is a scary, confusing, and complex process for patients. For health plans to fully support their members going through a cancer diagnosis, it’s critical to ensure that provider treatment recommendations are backed by science, evidence, and objective data. In addition, implementing a true patient-first approach for oncology treatment requires individualized strategies to address the following challenges:
- Avoiding provider abrasion to maintain a healthy working relationship with providers
- Augmenting your internal teams with the most up-to-date oncology drug information
- Ensuring that you are enabling the best, value-based treatment options for your members
Putting the patient first to help them achieve the best possible outcome is the primary mission of Oncology Analytics. The foundation of our patient-first approach to utilization management is based on optimizing clinical efficacy, toxicity avoidance, and cost-effectiveness in our treatment decisions. Our board-certified oncologists, radiation oncologists, hematologists, and pharmacists have operationalized protocols that cover all cancer diagnoses. These protocols are based on evidence-based guidelines from nationally recognized authorities such as NCCN, ASCO, and others.
100% Oncology Focused
What differentiates Oncology Analytics from other utilization management vendors, is our 100% focus on oncology. It’s all we do, every day. Our physicians, nurses, and PharmDs are certified in oncology. When a provider has a question about a cancer treatment for a member, they will only speak to a board-certified oncologist or radiation oncologist. This substantially limits provider abrasion and ensures that members get the care they need quickly.
With the oncology treatment landscape evolving so rapidly, we believe that analytics is a necessary part of oncology population management. Our data science teams utilize advanced data models and machine learning to better understand outcomes in all areas of cancer treatment, ensuring that your members receive the right treatment at the right time and the right cost. This approach facilitates our ability to provide treatment recommendations that reflect the most current evidence-based findings, even when there is a delay between when research is presented and its inclusion in NCCN.
Oncology Analytics works in concert with your providers as a dedicated clinical partner and patient advocate. Our treatment decisions are never based on cost alone, and we work to lower patient financial toxicity when possible. Instead of restricting options to certain pathways, we afford the treating oncologist full latitude in their prescribing, only intervening if necessary. Our staff of board-certified oncologists and oncology pharmacists proactively collaborate with providers on alternative treatment options and provide guidance beyond NCCN 1 and 2A scoring. Our e-Prior Authorization portal takes less than five minutes to submit a case, and our median turnaround time is two hours. All peer-to-peer consultations are conducted by board-certified oncologists; however, more than 96% of cases do not require a peer-to-peer consultation. In less than 2% of cases, a denial is issued, and the provider receives a detailed clinical justification with associated references for the basis of the denial.
Oncology Analytics understands the complexity involved in the management of cancer treatment options caused by the rapid pace of research and new drug introductions that are changing the oncology landscape daily. We can become a true extension of your oncology care team and are committed to the ongoing review and analysis of oncology treatments, their outcomes, and adverse effects to ensure that all cancer treatment recommendations provide the patient with the opportunity to achieve the best possible outcome.
If you would like to contact one of our specialists to discuss strategies for a patient-first approach to oncology care, please click here.