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.
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.
- 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.
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.