Abstract
In an environment of rapid innovation and sharply rising costs, oncology clinical pathways are a solution that can help bridge knowledge gaps for providers and ensure patients get quality, affordable cancer care. Cigna and eviCore Healthcare developed an Oncology Value-based Pathways (VP) program by incorporating several value frameworks and considering the perspectives of multiple stakeholders, including patients, providers, and payers. Starting January 1, 2021, the VP program was implemented for a large commercial population, spanning 51 clinical pathways and covering 50% of cancers. Over an 18-month period, the VP program increased the on-pathway regimen rate by 5.2%, leading to a cost savings of $24 million or $0.13 per member per month in a commercial managed population. Direct peer-to-peer conversations with providers who ordered off-pathway regimens led to updated requests for on-pathway regimens in 18.3% of cases. Additionally, 28.3% of total cases were moved to on-pathway regimens, regardless of whether there was a peer-to-peer discussion with the provider, indicating the VP program’s durable educational impact.
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