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Improving Member Cancer Care and Your Bottom Line

Billions of dollars are spent each year on healthcare waste, placing an increased pressure on health plans to reduce costs while ensuring quality care. Multiple studies of the quality of oncology care show that 30-40% of cancer patients receive care inconsistent with evidence-based medical guidelines. Most of these variations cannot be medically justified and at the same time, cost health plans in excess of $25,000 per patient receiving inappropriate care. Payers need an approach that addresses both quality and cost to improve cancer care in the U.S.

Health plans can use this handy buyer’s checklist to assess oncology authorization vendors to find the right fit.

The Eviti software platform considers all the standards of care that exist for cancer and allows a provider’s office to validate the treatment before it begins. On a payer-by-payer basis, the Eviti system is configured to evaluate each proposed treatment based on your medical and pharmacy policies, and on two chief definitions: what is medically necessary and what is experimental or investigational medicine. 

Eviti is an automated approval system – not an automated denial system. Guidelines and randomized trial results do not fit all patients. Consequently, the Eviti team of oncologists and clinical experts are prepared to explain these variances to you. Payer customers trust the Eviti oncology expertise and known due diligence.  

“Insurers typically don’t have a lot of doctors and the doctors they do have are not necessarily oncologists, so it’s difficult to keep up to speed,” says Eviti CMO, Dr. William Flood. “The medical director of one of our first clients told me 'I just talked to one of my oncologists about this drug he was giving, and the doctor told me if you can’t pronounce the word, you probably shouldn’t be telling me how to give it.’ And that’s the problem.” Health plans often struggle to have a meaningful discussion with practicing oncologists. With Eviti you are provided that necessary expertise.

Transparency is a huge factor in why payer clients trust Eviti. Transparency of data, costs, provider behavior and patterns are all presented. Eviti is not conflicted or owned by an insurance company, a doctor’s office or a big practice. “We do not have any financial gain in what drugs are or aren’t given,” Dr. Flood asserts.  

Eviti’s independence is another important factor, and the ability to provide a firm opinion that is trusted by both the payers and providers. Cancer therapy is expensive and as a result, depending on where you are in the market, there may be perverse incentives from recommendations on the best ways to treat the cancer. Are they the most effective? Is it a balance between cost and effectiveness? The Eviti library is visible to any practicing oncologist who chooses to review it through the Eviti Advisor tool. At Eviti, there is a rigorous process for vetting what populates the library, as well as for maintaining it. To ensure the library’s accuracy, the Eviti team does not exclude treatments based on their cost or the drug manufacturer.

Eviti helps to virtually eliminate appeals and denials. The Eviti approach is to align everybody on the same page before treatment begins, to avoid time wasted on non-reimbursed resources and keep your cash flow moving the way it should be. The numbers of appeals and denials that Eviti health plan customers now receive are in the single digits, because they get it right up front, so that doctors can focus on caring for cancer patients.  

“The most import thing about cancer care, is that the patients need all the care and support they can get while they’re dealing with this terrible illness,” says Dr. Flood. “When a patient’s care has gone through the Eviti process, they know that it’s of quality and matching up for them appropriately, so that they can focus on themselves,” Dr. Flood continues. “You have faith that it’s the right treatment for the patient.”

Click here to access the oncology authorization buyer’s checklist.

This article was created in collaboration with the sponsoring company and our sales and marketing team. The editorial team does not contribute.
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