Supporting a New Personal Best in Cancer Care

FEATURE
January 7, 2020
Vice President, Specialty Strategy and Client Solutions, CVS Caremark

Transform Oncology Care uses technology and the latest genomic science to solve some of the biggest challenges in oncology management today.

Getting diagnosed with cancer is a frightening, overwhelming experience. It is an expensive condition to treat and manage, with treatment costs expected to reach $207 billion by the end of next year.https://www.nih.gov/news-events/news-releases/cancer-costs-projected-reach-least-158-billion-2020, accessed 11/4/19. It is also the second-leading cause of death in the U.S., led only by heart disease, which it is expected to surpass by 2020.https://www.cdc.gov/pcd/issues/2016/16_0211.htm, accessed 11/4/19.

Timing is everything in cancer care. Delayed diagnosis or sub optimal treatment can lead to disease progression, higher morbidity and mortality, and higher costs. Getting patients on the most appropriate treatments can be challenging for providers trying to stay ahead of the rapidly evolving treatment landscape and standards of care. In 2018 alone, there were more than 500 updates to the National Comprehensive Cancer Network (NCCN) across 59 treatment and supportive regimens.https://www.nccn.org/disclosures/transparency.aspx, accessed March 29, 2019.

With the rapid and constantly evolving standards for cancer care, it can be challenging for even the most experienced oncologist to keep pace. There are 45 new cancer therapies scheduled to be approved by the U.S. Food and Drug Administration (FDA) in 2020 alone. Better cancer care management — tailored to patient needs and plan goals — can enhance quality of care and outcomes, while helping lower the overall cost of treating this complex condition. Transform Oncology Care strives to improve the oncology patient and physician experience by making it easier for providers to access the latest clinical guidelines, and empowering evidence-based decision making — tying care to quality metrics. In addition, by leveraging the local footprint and unique assets of CVS Health we can also help prevent, screen for, and detect cancer earlier for better disease management.

Transform Oncology Care strives to provide targeted strategies for every step of the cancer care journey.

1 Best therapy and treatment, faster
2 Best quality at a lower cost
3 Best experience for the patient
Transform Oncology Care strives to provide targeted strategies for every step of the cancer care journey.
1 Best therapy and treatment, faster
2 Best quality at a lower cost
3 Best experience for the patient

Real-time prior authorization (PA) integrated with NCCN Guidelines for further utilization management

Broad-panel gene sequencing for more complete, precise patient profile

Clinical trial recommendations to increase access to innovative therapies

Value-based provider contracts aligning provider-payor incentives

Optimize site of care and enable at time of PA to reduce cost of treatment

Proactive patient support to manage risks and reduce emergency room (ER) visits

Decrease medication errors

Reduce wasteful spend

Reduce therapy spend

Optimize provider performance

Redirect high-cost site of care

Fewer ER visits and hospitalization

Real-time prior authorization (PA) integrated with NCCN Guidelines for further utilization management

Decrease medication errors

Broad-panel gene sequencing for more complete, precise patient profile

Reduce wasteful spend

Clinical trial recommendations to increase access to innovative therapies

Reduce therapy spend

Value-based provider contracts aligning provider-payor incentives

Optimize provider performance

Optimize site of care and enable at time of PA to reduce cost of treatment

Redirect high-cost site of care

Proactive patient support to manage risks and reduce emergency room (ER) visits

Fewer ER visits and hospitalization

Helping Connect Patients to the Best Treatments, Faster

All patients, regardless of their cancer stage at the time of diagnosis, should be treated in accordance with evidence-based clinical guidelines. Transform Oncology Care uses the results of broad-panel gene sequencing tests and the latest NCCN treatment and supportive care guidelines to help providers select the most precise, appropriate treatment regimen based on the patient’s clinical and genetic profile. The strategy is enabled by a first-of-its kind collaboration with Tempus, a technology company advancing precision medicine through the practical application of artificial intelligence in health care, and delivered in close coordination with oncologists.

NCCN Guidelines offer treatment information for and are designed to improve safety and efficacy by enabling review and approval of regimen-based treatment rather than individual therapies, and yet they are not always used.

We partnered with NCCN to integrate their treatment Guidelines — which cover more than 97 percent of cancers affecting patients in the U.S. — directly into our web-based portal, enabled by Novologix, so physicians can select the most appropriate therapy combinations at the regimen level in real time, within their prescribing workflow.http://campaign.integraconnect.com/vbc-oncology-survey.

Therapeutic regimens that align to NCCN Guidelines, including those matched with the results of the broad-panel gene sequencing tests, will automatically receive PA approval 100 percent of the time, avoiding the need for additional approvals and speeding time to the start of therapy for patients.

Patients diagnosed with late-stage cancers can often benefit from advanced genomic testing, yet very few of eligible patients receive this type of testing today. This can delay the start of the most appropriate treatment and result in disease progression and higher costs.

94% of community oncologists think precision medicine is important to ensure appropriate use of future novel treatments.https://www.nccn.org/patients/clinical/default.aspx, accessed 11/4/19.

Our Novologix portal prompts oncologists to obtain Tempus’ broad-panel gene sequencing tests at diagnosis for patients with advanced stage cancers. Such tests are more comprehensive than the single-gene tests that are the current standard of care and can help identify a patient’s genomic variants and the therapeutic options specific to their molecular and clinical profile. They can also enable broader access to experimental therapies by enabling providers to match and enroll eligible patients in local clinical trials through Tempus’ proprietary platform.

The Novologix portal prompts oncologists to obtain broad-panel gene sequencing tests at diagnosis for late-stage cancer.

More than twice the 3-year survival rate for patients treated with broad-panel gene sequencing vs. non-matched patients.http://doi.org/10.1038/s41587-019-0259-z, accessed December 9, 2019.

Striving for the Best Quality at the Lowest Cost

Oncology drugs represent approximately half of the total cost of cancer treatment.Integra Connect analysis of 2017 CMS data. The rest is for other aspects of care, where there is significant opportunity to improve outcomes while lowering cost through value-based strategies.

As part of an integrated precision medicine approach, we work with prescribers on a shared incentive model to encourage them to follow treatment guidelines so that patients get the best treatment, while lowering overall costs to payors. This helps support better treatment for the patient by encouraging on-label prescribing and expanding access to novel therapies to the right patients at the right time.

Another way to address both cost and quality is at the site of care. Helping patients who are on certain infused medications transition from a costly outpatient hospital setting to a more effective site of care — such as home or a physician’s office — can save up to $270,000 per patient. Such settings can be as much as 50 percent lower in both drug and administration costs. Such sites are also more convenient for patients, and they can receive personalized one-on-one attention, as well as avoid exposure to opportunistic infections commonly found in hospitals.

A Better Experience for Patients

Oncology patients have complex and evolving needs and the traditional care delivery system often does not effectively support their unique needs. About 53 percent of oncology patients do not feel they receive adequate social or emotional support.http://cancersupporttexas.org/wp-content/uploads/2016/11/Access-to-Care-in-Cancer-2016-Embargoed-Slides.pdf, accessed December 9, 2019.

CVS Health developed a nurse-led care management approach that supports patients every step of the way. The program works by:

Checkmark Proactively identifying members at risk for adverse events and high cost – prior to therapy initiation – to facilitate timely nurse outreach to help manage side effects, and offer counseling for symptom and condition management.
Checkmark Providing ongoing support and interventions, including personalized digital tools and secure messaging.

Accordant engages with patients receiving high-toxicity treatments and informs patients regarding potential adverse events.

Want to learn how Transform Oncology Care uses precision medicine and genomics to help patients start on the right therapies faster and improve outcomes? Ask Us
FEATURE
January 7, 2020
Vice President, Specialty Strategy and Client Solutions, CVS Caremark

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