Health Plans | Utilization Management Medical Oncology

A pillar of eviCore’s Comprehensive Oncology suite, our Medical Oncology solution utilizes the most up-to-date evidence-based clinical guidelines from the National Comprehensive Cancer Network (NCCN®), a not-for-profit alliance of 28 leading U.S. cancer centers, to ensure that patients achieve optimal clinical and financial outcomes. Our solution guides providers to NCCN® recommended treatment plans for each unique patient by utilizing dynamic clinical decision support algorithms that minimize the administrative time required of providers. By capturing only the clinically relevant information for each case, we present providers with clinical decision support guidance and approval for a complete episode of care in as little as 4 minutes.

Challenges

As the population ages, an increase of new cancer cases are expected to be diagnosed. The number of patients undergoing active treatment for cancer has never been higher, the complexity of therapy options is proliferating, and patients are being treated for longer periods of time. Unfortunately, many medical oncology patients do not receive a treatment plan consistent with current medical evidence, primarily due to:

  • Drug use beyond the recommended lines of therapy
  • Inappropriate drug combinations within a treatment regime
  • Genetic testing not performed when indicated
  • Administration of highly toxic drugs to patients with poor performance status.

Frequently Asked Questions

What digital resources can I access to find out more information?
What is included in the medical oncology solution?

Our integrated and proven Medical Oncology solution is a vital component of our comprehensive oncology management solution:

  • NCCN® and eviCore evidence-based clinical guidelines for all cancer types
  • eviCore’s proprietary, regimen-based, and dynamic clinical decision support application designed for provider ease of use
  • Cost savings without the need to narrow regimens or the provider network
  • Inclusion of all therapeutic and supportive cancer drugs in one episode of care, including those covered under the pharmacy and medical benefits
  • Electronic transmittal of approved HCPCS and NDC codes
  • Post-service, pre-payment claims review.

Clinical Expertise

Working as a pediatric oncologist prior to joining eviCore healthcare, I had the privilege of caring for the most inspiring group of patients imaginable.  While I really miss spending time with those amazing kids every day, our healthcare system is badly broken.  The administrative burdens that physicians face are very real and worsening every year.  When I was presented with the opportunity to work at eviCore healthcare and join an innovative team with real-world experience who are focused on trying to fix the system, I saw my chance to influence meaningful change that could benefit everyone.  I am proud to work with such a highly dedicated group of experts who work toward that goal every day, while keeping our primary focus where it belongs—on the health needs of the patients we are honored to serve.

Dr. Eric Gratias

SVP & Chief Medical Officer, Oncology/Laboratory/Specialty Drug Services - Board Certified Pediatric Oncologist