- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
New research on innovative specialty management
Oncology research continues to bring focus to areas of care management, cost reduction and improved clinical results. While new treatments are constantly in development, investigating patient and provider needs can reveal ways to help improve access and services for those with cancer.
The annual meeting of the American Society of Clinical Oncology (ASCO) highlights recent research in cancer care. During this year’s meeting, CVS Health will present results highlighting the importance of innovative specialty management. Below are takeaways from our research.
Managing drug-related side effects
Patients undergoing treatment for cancer often visit emergency departments with drug-related side effects; frequent side effects can lead to hospital admissions. The nature of the side effect is the most important predictor of inpatient admission. Sepsis, pneumonia, medical complications, white cell disorders, metastatic cancer and fractures were associated with significantly higher risks of admission.
Site of service influences cost
Moving chemotherapy from a physician’s office setting to the hospital outpatient setting has emerged as a trend over the past decade and treatment costs increased.
While future studies are needed to determine the impact of clinical characteristics, genetic factors and treatment choice, optimizing for lower-cost sites of care with infusions can significantly influence the cost of oncology care. In fact, infusing many cancer drugs can be safely done in a patient’s home once a patient is stable.
Addressing adherence in the beginning
Side effects can also play a role in drug adherence. Patients with hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer treated with abemaciclib often experience adverse events, specifically diarrhea. We sought to determine whether adherence differs for patients who receive loperamide in welcome kits versus those who do not receive loperamide in welcome kits among a population of 1,180 patients; there was no significant difference in adherence between the two groups.
Reducing administrative burden while elevating quality of care
Improving oncology care and treatment outcomes using a regimen-level prior authorization (PA) tool can lead to cost savings. CVS Health offers clients Novologix, a web-based clinical decision platform that approves cancer treatments at the regimen level rather than the drug level to reduce provider administrative burden. Evidence-based guidelines in Novologix are updated in real time through a partnership with the National Comprehensive Cancer Network (NCCN). The study evaluated the total cost of care for Medicare Advantage patients with non-small cell lung cancer who received NCCN concordant versus non-concordant therapies.
Results suggest that engaging oncology practices through an enhanced payer–provider collaboration and implementing an automated regimen-level precertification process with real-time NCCN updates can facilitate lower costs and more efficient oncology care.
The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.
Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.