Transform Oncology Care

Helping manage treatment costs and working toward improved outcomes.

Cancer, the second leading cause of death in the United States, and managing oncology continue to be top challenges in health care. Cancer care and management are expensive with costs expected to rise 34 percent to nearly $246 billion by 2030. But cost is only part of the equation. Cancer care is complex for patients and providers. Such complexity can affect the overall quality of care as well as the patient experience.

Cancer costs are expected to rise by ~34% by 2030
Cancer costs are expected to rise by
~34% by 20303

Plans and payors must balance and manage the quadruple aim of cancer care: lower costs and improve quality, patient experiences and the provider experiences. Cost concerns and complications may unintentionally create gaps in cancer care. 

CVS Health helps control the high cost of therapy while improving the patient and provider experiences. Our Transform Oncology Care (TOC) solutions are also designed to help manage the complicated cancer journey, which also supports lower overall costs.

At CVS Health, we continue to invest in and evolve our solutions to be the best partner at each stage of the plan member’s cancer care journey. TOC does just that.

Transform Oncology Care can deliver up to $32M reduction in drug and medical cost per 1M lives. $2.65 per member per month (PMPM)
$2.65 per member per month (PMPM)
Transform Oncology Care can deliver up to $32M reduction in drug and medical cost per 1M lives.

CVS Health, through Transform Oncology Care, addresses challenges and provides strategic support for each stakeholder – patients, providers and the payor – with flexible solutions to address cost and care. 

Would you like to learn more about how we can maximize your specialty cost savings? Contact us
Would you like to learn more about how we can maximize your specialty cost savings?
Contact us

Strengthening the diagnosis and therapy starts

TOC helps to enhance the diagnosis process when providers start therapy with certainty, which helps control costs and decreases disease progression. 

Providers must keep pace with continuously changing National Comprehensive Cancer Network treatment and standards of cancer care guidelines (NCCN Guidelines®). This can have an impact on what type of treatment is – or should be – prescribed. 

~25% lower treatment costs®
when aligned with NCCN Guidelines®
$8,500 PMPM cost reduction
for metastatic breast cancer patients
~25% lower treatment costs
when aligned with NCCN Guidelines®[#]
$8,500 PMPM cost reduction
for metastatic breast cancer patients[#]

Broad-panel gene sequencing enables precision medicine, to better target genetic differences within cancer types. Together with the latest clinical guidelines, they help empower informed treatment decision-making based on a patient’s clinical and genetic profile for the best chance for successful treatment and improved quality of life. Patients receiving broad-panel gene sequencing had more than twice the three-year survival rate than those who did not receive

When these clinical rules and personalized genetic information is integrated into the provider’s treatment protocol with real-time prior authorization (PA) they get the most informed criteria immediately for oncology authorizations. We also have a team of clinicians with oncology expertise, including oncologists, that are available for peer-to-peer discussions and other clinical consultations. This strategy is different because it allows the measurement of results for payors and enables oncologists and payors with actionable insights. Our resources help support better patient and provider experiences. 

We have strong relationships with:

patients have received support
patients have received support

Supporting each treatment stage

TOC supports each treatment stage and allows payors to select solutions to help manage treatment costs including by reducing medical drug waste and recommending quality, lower cost sites of care. In addition, TOC can help reduce costly hospitalizations through care management nurses, who customize the level of care management based on a member’s specific needs throughout treatment. Video education is used in addition to telephonic and digital outreach.

Symptom resolution occurred in most cases when patients engaged with a nurse. Informing patients early in their journey about symptoms and tracking symptoms help to keep them on appropriate therapies with greater adherence and earlier identification of adverse events. Frequent touchpoints and data sharing help drive better patient experience as well as cost savings.

Providing the right solutions

Payors can choose solutions that are right for the plan or can implement a comprehensive solution to address each point along the cancer care journey to drive high-quality care and help to lower costs. Comprehensive reporting and outcome information are provided to demonstrate impact. This helps ensure better treatment for the patient by encouraging expanding access to novel therapies to the right patients at the right time. Using a value-based contract helps to align the right solution with the payor’s needs and address unintentional gaps in oncology care for all stakeholders.

Additionally, our new Radiation Oncology solution is designed to encourage simple and value-driven utilization and help enhance plan members’ cancer outcomes. A Radiation Oncology clinical pathway, reflecting the dynamic national standard of care, is built into the automated prior authorization system of Novologix. It requires minimum essential information and ensures high rates of real-time approval. This process enables providers to select the most appropriate therapy for their patients and improves the efficiency of the prior authorization process. 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.

Need more information about how customizable Transform Oncology Care solutions lower costs? Ask Us