By William Flood, MD, Eviti at NantHealth
An increasingly effective arsenal of preventive interventions, screenings, drugs and other therapies has contributed to a reduction in cancer incidence and better survival, but the improvement comes at a staggering cost to patients. The expense of cancer care, which has doubled in recent years and is expected to soon double again as we gain access to hundreds of new, more expensive therapies, is financially crippling patients. Healthcare has cost more than 40 percent of cancer patients their life savings and cancer patients are more than twice as likely to file for bankruptcy.
As healthcare providers, it’s our duty to prescribe the best treatment for our patients. It’s also our fiscal responsibility to ensure that we are providing care that is accessible. But how can providers keep track of the staggering amount of data available to them, including emerging new therapies, better identification of subgroups of patients using biomarkers and other measures, disease outcomes, toxicities, and costs? We need assistance from technology to help us process data to reveal patient-centric solutions with evidence-based outcomes—avoiding expensive trial and error treatments— and better align our processes with payers so that patients get the best possible, pre-authorized treatment as quickly as possible.
Costly, Complex Cancer Care Demands Support
As published in the Journal of Clinical Oncology, estimates show that by 2020 physicians will need to consider approximately 10,000 decision data points per case to align evidence-based, best care outcomes and cost. Scores of promising new cancer drugs are more imminent or pending FDA approval, costlier than their predecessors, which cost on average $150,000, excluding hospitalization, outpatient costs, and supportive therapies often associated with their use. In addition to new drugs soon to be at their disposal, physicians must also consider a growing number of care modalities—new surgeries, radiation and systemic therapies.
These new treatment options add to the expense and the complexity of care decisions. Sadly, it is estimated that approximately 30 percent of prescribed cancer treatment plans deviate from evidence-based standards, needlessly increasing costs without delivering clinical benefit to patients. We need better ways to evaluate the staggering amount of research and available therapies, and more streamlined methods for selecting treatment and securing health plan approvals for treatment decisions based on proven success rates.
The Right Solution To Cut Cancer Care Costs
Healthcare is riddled with technology that impedes, rather than improves care. Rather than serving as an obstacle, IT solutions need to bring patients, providers and payers together and empower them by providing pathways to well established, evidence-based treatments with proven effectiveness.
Solutions must help to ensure cost-effective treatments and appropriate reimbursement by offering the ability to create and submit authorizations electronically and allowing intelligent treatment plan review and selection. When treatment is integrated with health plan medical policies and define regimen preferences seamlessly, it allows providers the real time to near real time insight into treatments that meet the plan’s requirements for reimbursement.
NantHealth’s Eviti Connect is a patient-centric solution that aligns providers and payers. It provides a comprehensive database with actionable treatment data and eliminates unwarranted variability in care—that often results in wasted costs—by presenting nationally-accepted treatment standards with evidence-based therapies.
It ensures that insurance approvals happen at the moment of clinical prescribing, rather than at the back-end review, after treatment has begun. This assures patients, providers and payers that the patient is started on high quality therapy from the start, avoiding later treatment interruptions, appeals and denials—unneeded and frustrating events for all stakeholders. At the same time, it optimizes the opportunity for health plan savings and assuring appropriate reimbursement by providing visibility into the costs of care before treatment begins.
HIT Aligns And Benefits Stakeholders For Better Care And Lower Costs
Technology has driven the evolution of patient-centric cancer care by demanding transparency and providing access to information that enables patients, providers and payers to become true partners in healthcare decisions.
The right solution connects and benefits all players:
- Patients are informed and engaged in their healthcare. They have peace of mind that they are receiving the most appropriate treatment for their disease and have visibility into associated costs.
- Physicians are guided to evidence-based care and receive appropriate reimbursement from health plans.
- Healthcare plans are assured their members are getting the right care cost-effectively.
Ultimately, the connection and access that technology provides to patients, providers and health plans leads to better patient outcomes and reduces the heavy burden of costs associated with the care they require.
About The Author
William Flood is the Chief Medical Officer for Eviti at NantHealth, a next-generation, evidence-based, personalized healthcare company enabling improved patient outcomes and more effective treatment decisions for critical illnesses. Prior to his role within NantHealth, Dr. Flood has served as Assistant in Oncology at the Johns Hopkins Oncology Center, Assistant Professor and Associate Professor of Medicine at the Penn State College of Medicine. He is a multi-time graduate of Penn State (BS - Molecular/Cell Biology; MS - Health Evaluation Sciences) and the Temple University School of Medicine. He performed his post graduate medical training at the Duke University Medical Center and the Johns Hopkins Oncology Center. While in active clinical practice, Flood was named a "Best Doctor in America" many years.