Study: First-of-its-Kind Online Chemotherapy Approval Protocol Accelerates Cancer Patients' Access to Proven Treatments
October 20 2016 - 12:02PM
Business Wire
Journal of Oncology Practice publishes
results of a UnitedHealthcare pilot that expedited treatment
approvals, increased coverage approval rates and lowered treatment
costs
A study of a new web-based tool piloted with select medical
oncology practices in UnitedHealthcare’s care provider network in
Florida found 99 percent of cancer patients received approval for
chemotherapy drug regimens immediately or within 24 hours. The
pilot also reduced cancer drug costs by 20 percent compared to
UnitedHealthcare’s cancer drug costs nationally, and all treatments
were evidence-based and in alignment with the recommendations of
the nation’s leading cancer centers.
The tool incorporates real-time guidelines from the National
Comprehensive Cancer Network® (NCCN®) into the oncologists’
decision-making process. The online program showed physicians all
available NCCN-recommended options during the request; choosing any
one of these options resulted in an immediate approval. NCCN
Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are
trusted by health care professionals around the world to help them
determine the best way to treat cancer patients. UnitedHealthcare
automatically approves coverage for all regimens that align with
NCCN Guidelines®. The online tool was developed by eviCore
healthcare, which manages UnitedHealthcare’s injectable
chemotherapy program.
“The program puts information at oncologists’ fingertips to help
them ensure that their patients will be covered for proven cancer
treatments that offer the greatest promise for survival and quality
of life,” said Lee Newcomer, M.D., UnitedHealthcare senior vice
president of oncology. “The objective of the pilot was to ‘get to
yes’ by offering all available evidence-based treatment options at
decision time.”
Details of the study, “Transforming Prior Authorization to
Decision Support,” were published Oct. 18 in the peer-reviewed
publication, Journal of Oncology Practice. The article was
co-authored by Dr. Newcomer; Robert W. Carlson, M.D., CEO of NCCN;
and Richard Weininger, M.D., senior strategic advisor and former
chief medical officer of eviCore healthcare.
“Collaborative, evidence-based programs such as this create a
win-win for patients, care providers and health plans. NCCN
appreciates UnitedHealthcare’s creativity and willingness to
explore a cost-effective approach to cancer treatment that enables
care providers to select among the most appropriate
Guidelines-based options for each patient,” Dr. Carlson said.
“eviCore is proud to be part of this effort, and we are pleased
with the study results showing use of the online tool helps
expedite treatment approvals and reduce cancer treatment costs,”
said Dr. Weininger.
The program will help advance cancer research and patient care
by contributing to a database that will enable UnitedHealthcare to
identify top-performing regimens by cancer type. The company plans
to publish comparative results late next year.
Pilot HighlightsThe online
program was piloted by all medical oncology practices in Florida
that are part of UnitedHealthcare’s care provider network. The
pilot was conducted over one year, from June 2014 to June 2015.
Key results:
- Of the 4,272 eligible cases during this
period, oncologists using the online tool obtained immediate
approvals 58 percent of the time, within an average approval time
of less than five minutes.
- Of cases that required a peer-to-peer
discussion, 95 percent were granted coverage approval for an
evidence-based chemotherapy regimen in less than 24 hours.
- Only 1 percent of eligible cases were
denied authorization. Historically, approximately 7 percent of
UnitedHealthcare chemotherapy drug claims were being denied each
year.
Use of the online tool also was associated with reduced cancer
treatment costs. UnitedHealthcare’s chemotherapy drug costs in
Florida dropped 9 percent during the period Jan. 1, 2015, to Sept.
1, 2015, compared to the same period a year earlier. Over the same
timeframe, UnitedHealthcare’s cancer drug costs increased by 11
percent and 10 percent in the Southeast region (outside Florida)
and United States, respectively.
Prior authorization is commonly used by health plans,
including UnitedHealthcare, to evaluate proposed treatments for
coverage criteria before they are administered. At this time,
UnitedHealthcare is using the tool to authorize coverage of
injectable chemotherapy drugs administered on an outpatient
basis.
An oncologist securely logs in and enters the patient’s health
information, cancer type and proposed treatment regimen. The
application then compares this information with NCCN Guidelines. If
they align, authorization is immediately granted. If not, a
follow-up peer-to-peer discussion is held to identify suitable
alternatives.
About
UnitedHealthcareUnitedHealthcare is dedicated to helping
people nationwide live healthier lives by simplifying the health
care experience, meeting consumer health and wellness needs, and
sustaining trusted relationships with care providers. The company
offers the full spectrum of health benefit programs for
individuals, employers and Medicare and Medicaid beneficiaries, and
contracts directly with more than 1 million physicians and care
professionals, and 6,000 hospitals and other care facilities
nationwide. UnitedHealthcare is one of the businesses of
UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and
well-being company.
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version on businesswire.com: http://www.businesswire.com/news/home/20161020006169/en/
UnitedHealthcareLynne High,
952-979-5861Lynne_m_high@uhc.comorNCCNKatie Brown,
215-690-0238Brown@nccn.orgoreviCore healthcareMark Ciamarra,
800-918-8924, x27975mciamarra@evicore.com
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