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Integrative Oncology Program Improves Efficiency and Outcomes in Oncology Care

Amit Gupta, MD
Advances in cancer treatment provide more options for patients but add complexity to treatment decisions. HealthHelp’s Integrative Oncology program coordinates care to maximize efficiency and ensure optimal outcomes for cancer patients.
Rapidly developing medical technology presents both benefits and challenges to cancer patients and physicians. Although the number of treatment options now available improve quality of life and survival rates for patients, they also make physicians’ selection and coordination of treatments more complex. Care is further complicated by the rising cost of cancer treatment. Total costs are projected to be between $158 billion and $173 billion in 2020, a 39% increase from 2010.1 In addition, some newer cancer drugs now cost $10,000 to $30,000 per month. Patients typically pay 20% to 30% out-of-pocket for drugs, so an average year’s worth of new drugs could cost $24,000 to $36,000 in addition to health insurance premiums.2 These expenses exceed many patients’ ability to pay, and many are forced to simply forego treatments.3 It is critical that patients receive the best possible treatment at the lowest possible cost.
Integrative Oncology
Achieving efficiency and optimization of treatment is the goal of HealthHelp’s new Integrative Oncology program. HealthHelp uses evidence-based guidelines to advise and educate physicians on the most appropriate tests and procedures based on their patients’ symptoms and health history. The goal is to improve provider compliance with oncology care guidelines, which improves patient care and outcomes, while reducing waste caused by unnecessary testing and procedures. 
HealthHelp is the first specialty-benefits manager in the nation to offer an Integrative Oncology program. The process begins by identifying a patient’s risk level and, through adaptive algorithms, determining the most appropriate care alongside specialty nursing and physician support. As a patient’s risk level changes, clinical decisions adapt to the patient. HealthHelp is unique in the utilization management industry in that its specialists, drawn from major academic and medical institutions, will proactively call physicians before they even make an authorization request for their patients, in order to provide guidance on their choice of testing and treatment. This physician peer-to-peer program gives the provider a sounding board to discuss appropriate care and offers education on the best treatment for each patient. This multi-institution advanced treatment planning can also influence tumor board decisions on how to best care for patients.
The Integrative Oncology program considers the totality of the patient receiving a full array of services, encompassing the management of 3 modes of therapy:
  • Radiation therapy, including intensity-modulated radiation therapy (IMRT), brachytherapy, 2D/3D conformal radiation, stereotactic radiosurgery and radiotherapy, and proton beam therapy. 
  • Medical oncology, including chemotherapy, hormone therapy, prophylactics, and biologic agents. 
  • Oncology surgery, including wedge resections, lobectomy, lumpectomy, and others.
This integrative approach to cancer care makes it easy for physicians in different specialties to collaborate and coordinate the treatment a patient receives, developing one cohesive continuum of care. Since patients with cancer frequently work with multiple physicians, cross-specialty coordination is especially important to ensure quality care. The Integrative Oncology program gives radiology and oncology providers access to patient information that may have been administered by a provider in an alternate department or even an alternate facility. This helps to eliminate duplicate or unnecessary testing, which increase patient risk and costs. 
The main components of the Integrative Oncology program are:
  • Risk assessment and screening. Patient risk is calculated in real time during the authorization process, and the patient is categorized into a risk population based on published, evidence-based literature. Based on his or her category of risk, the patient will be steered to the most cost-effective and appropriate treatment.
  • Imaging and staging work-up. This follows a patient when a positive screening has occurred or a request for an authorization comes in for incidental findings, such as lumps, nodules, or masses. There are extensive prediagnosis guidelines for the initial work-up to ensure physicians select the proper sequence of imaging to prevent overtesting or unnecessary testing.
  • Biopsies and interventions. HealthHelp’s risk segmentation ensures that high-risk individuals get timely diagnosis and early resection of low-stage cancerous findings, while low-risk individuals do not receive excessive interventions and imaging due to high false-positive rates. Proper upfront screening and imaging schedules are also used to prevent unnecessary biopsies and interventions that are inconvenient and cause anxiety among patients.
  • Prognostic assessment. Oncologists and the clinical team reach out and gather information on cancer patients who are undergoing staging and work-up for prognostic assessment. This takes into account the patient’s disease stage, clinical parameters, histopathology, and molecular characterization to determine the patient’s prognosis. This is key to treatment planning and distinguishing between a curative or a palliative path for the patient.
  • Treatments and surgeries. This includes chemotherapy, biotherapeutics, ancillaries, radiation therapy, excisions, and surgeries.
  • End-of-life care with palliative and curative pathways. By constantly reevaluating a patient’s stage and prognostic indicators, and through case management, the patient’s wishes can be more closely followed if palliative care is needed. If a palliative pathway is determined, to ensure maximum patient comfort, HealthHelp coordinates physical therapy/occupational therapy, pain management, home health nursing, and other services.
  • Advocacy/peer oncologist. HealthHelp monitors a patient’s timeline of diagnosis, staging, treatments, and other care needs, so that when appropriate, a peer oncologist can intervene in the process. The peer oncologist creates personalized interactions with both providers and patients to ensure coordination of care, treatment planning, and shared decision making.
  • Genetic testing and precision testing. Not everyone is a candidate for genetic testing. Whereas it may be warranted for patients identified as being at greater risk for cancer, it’s an unnecessary expense for many patients. Similarly, certain chemotherapy drugs target specific cancers caused by genetic mutations, such as Avastin (bevacizumab) for recurrent glioblastoma, a type of brain cancer. With precision testing, a biopsy will show whether a patient’s tissue responds to the medication. If it does, the drug is authorized because it clearly works on that patient. If the tissue doesn’t respond, there is no point in prescribing the medication.
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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