Two Groundbreaking Cancer Care Programs from UnitedHealthcare Help Improve Patients’ Access to Quality Treatment

October 29, 2015
  • UnitedHealthcare expands Episode Payment Program that rewards physicians for better cancer care
  • Online chemotherapy approval process speeds access to life-saving cancer treatment

UnitedHealthcare is advancing new approaches to cancer treatment with two groundbreaking programs that help put patients’ needs at the center of care.

UnitedHealthcare is expanding its pioneering cancer care payment model, first launched in 2010, that rewards physicians for focusing on quality patient care, best treatment practices and health outcomes. A study published in the Journal of Oncology Practice demonstrated this program reduced overall cancer expenses by more than a third while improving quality outcomes. Five additional oncology practices – including 550 oncologists – are now joining the program, bringing the total number of oncologists to approximately 650 in seven states.

Additionally, UnitedHealthcare is launching a first-of-its-kind chemotherapy approval program that will provide real-time decision support and approvals for therapies based on National Comprehensive Cancer Network® (NCCN®) treatment recommendations from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). NCCN is the leading independent source for clinical recommendations that guide chemotherapy treatments. UnitedHealthcare provides online displays of all recommended treatments for a patient’s specific condition during the approval process, accelerating access to life-saving treatments for people with cancer and helping speed coverage approvals.

Both programs underscore UnitedHealthcare’s commitment to new approaches to cancer care that encourage best practices for effective treatment in cancer care.

Fast-Track Drug Approval Program
The fast-track drug approval program gives oncologists a new way to get to “yes” with an intuitive online tool that quickly verifies benefits coverage for drug regimens that meet NCCN Guidelines for injectable chemotherapy drugs administered on an outpatient basis. Real-time approvals are possible because the tool automatically populates the NCCN-recommended treatments based on the patient’s specific clinical condition. Once the physician confirms the treatment is consistent with NCCN Guidelines, UnitedHealthcare issues an immediate coverage approval. This ensures the patient gets fast access to the best treatment. The tool was developed by NCCN and eviCore Healthcare.

“This new online tool tailors recommendations to the patient’s specific condition,” said Lee Newcomer, M.D., UnitedHealthcare senior vice president of oncology. “In many cases, patients can now get instantaneous approval for their treatments because the smart technology automatically links the relevant cancer treatment guidelines with the requested chemotherapy.”

Since the program was launched in June, UnitedHealthcare has completed more than 17,000 reviews with only one appeal. Among those reviews, physicians received an instant approval for nearly 70 percent of the requests. Only 1 percent of the requests were not approved by the end of the process.

Some requests may require additional clinical information or review by an oncologist, but are still completed within three business days or less.

“NCCN is dedicated to advancing high-quality, high-value cancer care through the publication of evidence-based treatment recommendations that enable clinicians to work alongside their patients to make well-informed treatment choices,” said Robert W. Carlson, M.D., CEO of NCCN. “We commend UnitedHealthcare’s effort to accelerate patients’ access to the best and most appropriate care available based on their individual clinical conditions as outlined by the NCCN Guidelines.”

UnitedHealthcare has been using this new online tool in a pilot program in Florida since May 2014. Physician response to the Florida pilot has been favorable, with some oncologists describing the new process as “the most logical, easy-to-use and appropriate system in the market.” 

The online tool also will help advance cancer research and patient care by building a database that will enable UnitedHealthcare to analyze comparative effectiveness among different chemotherapy treatments for the same type of cancer; the company expects to publish the first comparative-effectiveness results in two years.

Episode Payment Program Leads to Better Care for Patients
UnitedHealthcare is expanding its episode cancer care payment initiative, another program to improve cancer care treatment. The program pays participating medical oncologists more if they demonstrate superior clinical results and reduce the total costs of care.

The episode payment model shifts reimbursement away from the current “fee-for-service” approach that emphasizes volume of care delivered regardless of a patient’s health outcomes. The episode payment is based on the expected cost of a standard treatment regimen for the specific condition, as predetermined by the doctor. Similar payment models have shown to enhance care coordination and improve health outcomes for patients, while reducing overall costs.

UnitedHealthcare first implemented its episode payment program between October 2009 and December 2012 in a pilot study, which produced a significant reduction in hospitalizations for patients and a 34 percent reduction in total costs while improving quality. Click here to read results of the study.

The more than 550 physicians joining the program are from five practices nationwide: Texas Oncology, with multiple locations in Texas; Rocky Mountain Cancer Centers, with multiple locations in Colorado; OHC, Specialists in Cancer and Blood Disorders in Cincinnati; Cancer Specialists of North Florida with multiple locations in Florida; and Tulsa Cancer Institute in Tulsa, Okla.

“We applaud UnitedHealthcare for enhancing its cancer care payment approach,” said E. Randolph Broun, M.D., president and chairman of OHC. “Our partnership complements our mission of ensuring that patients receive optimal care, when and where they need it, and in the most cost-effective manner.” 

UnitedHealthcare’s episode payment initiative is part of a growing national movement to explore new care and payment models. This marks the program’s second expansion, following the successful pilot that began with five oncology groups and a second pilot established at MD Anderson in December 2014.

“This streamlined payment process, coupled with oncologists sharing best practices and learning from one another, put patients’ interests at the forefront of cancer treatment,” said Dr. Newcomer. “It also results in significant cost savings. We look forward to working with additional medical practices to expand our efforts to identify best practices for treating cancer and deliver effective science-based care to more people who are dealing with this complex disease.”

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, military service members, retirees and their families, and Medicare and Medicaid beneficiaries, and contracts directly with more than 850,000 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. For more information, visit UnitedHealthcare at or follow @myUHC on Twitter.