Blog | Care Management

Analysis: CVS launches oncology program marrying precision medicine with care management

Blog | Care Management

Analysis: CVS launches oncology program marrying precision medicine with care management

  • On Dec. 12, CVS Health unveiled a precision medicine program for oncology patients designed to increase access to broad-panel gene sequencing tests for patients with specific advanced stage cancers, according to Healthcare Dive.
  • CVS-owned payer Aetna has already adopted the program for its fully insured commercial beneficiaries and is rolling it out with participating Aetna provider networks in 12 states, according to the Healthcare Dive article.
  • UnitedHealthcare’s oncology bundled payment program significantly reduced costs due to the savings from better care management, resulting in fewer trips to the ED and/or inpatient admissions for patients undergoing treatment.

Healthcare Dive is reporting, “CVS Health unveiled a precision medicine program for oncology patients Thursday [Dec. 12]  designed to increase access to broad-panel gene sequencing tests for patients with specific advanced stage cancers. The Woonsocket, Rhode Island-based healthcare behemoth is partnering with Tempus, a precision medicine company, to help clinicians develop a personalized regimen for cancer patients to limit disease progression and reduce unnecessary costs. Results from the genetic tests will also be used to match eligible patients to clinical trials in their area. CVS-owned payer Aetna has already adopted the program for its fully insured commercial beneficiaries and is rolling it out with participating Aetna provider networks in 12 states.”

“The latest program includes: value-based contracting with oncology providers; local access to screenings and preventive services offered at CVS HealthHUBs; pharmacies and MinuteClinics; nurse-led care management integrated with a payer's existing programs to close existing gaps in care; and provider access to evidence-based guidelines from the National Comprehensive Cancer Network. Participating oncologists will have access to a portal built into the e-prescribing workflow in their electronic health record system informing them of Tempus' broad-panel gene sequencing tests at the point of diagnosis. Broad-panel tests, which identify a patient's genomic variants from the norm and suggest personalized therapeutic options, will also be used to match eligible patients to local clinical trials for experimental therapies.”

Takeaway

The pairing of precision medicine and care management have the potential to significantly reduce spend and improve patient outcomes. UnitedHealthcare’s oncology bundled payment program significantly reduced costs. However, the savings came from better care management – resulting in fewer trips to the ED and/or inpatient admissions for patients undergoing treatment.

It will be interesting to see if and how Aetna can effectively integrate its nurse care managers into the workflow of the participating oncologists’ practices as this is likely one of the biggest challenges to implementation.

Several of the keys to this will be:

  • Ensuring that the Aetna care managers have access to the practice’s EHR so they have real-time visibility into the patient’s care plan
  • Defining what activities are the responsibility of the Aetna care manager
  • Determining which care management activities belong to the practice
  • How to effectively communicate this information the patient

At the end of the day, the patient needs to know who to call if they’re not feeling well at 5 p.m. on Saturday and are considering going to the ED. I guess my one open question is, How, or if, Aetna is changing its payment model for oncologists who choose to participate in the program?

The cost of therapeutic agents went up significantly in the UHC pilot. The use of precision medicine should help identify the best treatment the first time around, which should in many instances reduce the overall cost of therapeutic agents by hopefully eliminating the need for second and third rounds of alternative therapies. More importantly than the cost, it should also improve outcomes. If first-line treatments are more successful, not only does the mortality rate decrease, but the amount of therapy — along with the side effects — patients must endure should be decreased as well.   

About the Author

Chad Mulvany, FHFMA,

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office.

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