[October 20, 2016] |
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Study: First-of-its-Kind Online Chemotherapy Approval Protocol Accelerates Cancer Patients' Access to Proven Treatments
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 thiscreate 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 Highlights The
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:
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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.
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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.
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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 UnitedHealthcare UnitedHealthcare
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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