Using Data to Guide Higher-Value Cancer Care: David Johnson, MD, MPH

A data-driven approach to utilization management can shift patients with cancer away from low-value care, such as acute hospitalizations, and toward high-value supportive services and cost-efficient sites of care, particularly when payers and oncologists collaborate, David Johnson, MD, MPH, told The American Journal of Managed Care^® in part 1 of an interview at the Community Oncology Alliance Payer Exchange & Innovation Summit.

Johnson, co-founder and chief physician executive at Atlas Oncology Partners and clinical associate professor of urology at UNC Health Care, was a panelist during the session “The Evolution of Utilization Management: Data-Driven Decision-Making” on September 14. He and fellow experts examined how utilization management is evolving through greater use of data and technology. The panel also discussed prior authorization, gold carding, patient steerage, and care navigation, with a focus on how data-driven approaches can reduce administrative burden while supporting appropriate oncology care access.

Johnson said Atlas works to reduce low-value utilization, particularly acute hospitalizations, emergency department visits, and low-value end-of-life care, while increasing uptake of high-value services such as psychosocial support, electronic patient-reported outcomes, remote patient monitoring, palliative care, and advance care planning discussions. Atlas does not conduct prior authorization or utilization management of cancer drugs, he noted.

“We leave that to the oncologists,” Johnson said.

Oncologists have limited visibility, however, into what happens to patients outside the office, Johnson said. As a result, when Atlas contracts with a payer, it receives longitudinal, whole-person claims data that can help identify risk factors for hospitalization and low-value end-of-life care and match patients with the right services at the right time.

Payer data can also identify the most cost-efficient sites of care, Johnson said. Avoiding facility fees can lower the total cost of care for payers while reducing copays and financial toxicity for patients.

He stressed that this is best done in collaboration with oncologists, who typically place the orders and tell patients where to go for procedures, imaging, or lab work.

“I think having that collaboration to understand the cost differential and the quality and access differential between a facility vs an outpatient center is really important,” Johnson concluded.