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Accelerating Innovation in Radiation Oncology
Cancer care is complex. Giving members access to clinically appropriate care in a timely manner shouldn’t be.
As part of our Transform Oncology Care program, we’re simplifying the prior authorization process by seamlessly integrating up-to-date evidence-based treatment guidelines, easing administrative burden for providers, and enabling access to clinically appropriate therapy faster.
More than half of all cancer patients get radiation therapy as part of their treatment, whether it’s given alone or in conjunction with other therapies.
Prior authorization can help ensure treatments align with the latest evidence-based standards of care and control medical spend, though the experience is often complex and time-consuming.
- Each patient requires unique treatment.
- There are no clear guidelines for prescribers.
- Visibility into current information is lacking.
- Third-party reviews are inconsistent and unverified.
- Peer-to-peer review and appeals processes are inadequate.
Not surprisingly, prior authorization for radiation oncology services is often a pain point.
|97% of procedures require prior authorization
||73% of radiation oncologists said their patients express concern over prior authorization delays
||17% of radiation oncologists spend more than 10% of their day on prior authorizations
We’ve created a solution that simplifies the process, seamlessly integrating up-to-date evidence-based treatment guidelines, easing administrative burden for providers, and enabling access to clinically appropriate therapy faster.
Robust clinical guidelines to help providers select appropriate care from the start
Our solution incorporates up-to-date clinical guidelines that align with the American Society for Radiation Oncology (ASTRO), the National Comprehensive Cancer Network (NCCN), and evidence-based standards of care. When providers select clinically appropriate therapy, patients can get started on their treatment faster. Additionally, board-certified radiation oncologists help support cases that aren’t automatically approved.
Simplifying the process to ease administrative burden and save time
We leverage our innovative Novologix prior authorization platform, with a built-in radiation oncology clinical pathway that reflects dynamic national standards of care. The platform helps providers select the appropriate benefit and guides them through the process electronically. It requires minimum essential information and ensures high rates of real-time approval.
- Providers and staff can create a request in just minutes and get a decision or approval in as little as one minute.
- All required documents can be requested and submitted online, eliminating the need for phone calls and faxes.
A streamlined and quality-focused prior authorization experience for providers
This translates to patients receiving clinically appropriate treatment faster, providers spending less time on prior authorization, and health plans having an end-to-end solution that delivers value.
Payors save 5.8 percent on radiation treatment.
Savings calculated on commercial fully insured spend on radiation treatment. With an estimated 15% overutilization of advanced radiation modalities, helping ensure that members receive a clinically appropriate radiation modality can help lead to cost savings. CVS Health Analytics, 2022. Data from January 1, 2019 to December 31, 2019. All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Once we have these claims, we model how the Utilization would have been different if we had shifted 15% utilization from Proton Therapy to IMRT or from IMRT to Conformal Radiation. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan, clinical appropriateness as determined by treating physician, and other factors.
At CVS Health, we’re building solutions that help improve oncology care experiences and health outcomes, while speeding the process and lowering costs.
Want to learn more about how our Transform Oncology Care solutions improve care experiences for both patients and their providers? Ask Us