Solutions Overview

Today’s cancer treatments are varied, complicated and costly. Oncology Analytics provides the critical missing link between health plans and providers – which is access to current, evidence-based, disease-specific analytics on all cancer types and treatment options.

Utilization Management, Purpose Built for Oncology

Oncology Analytics can save health plans 10-40% on total cancer drug expenditures by improving access to data, analytics and insights on treatment options. We help health plans achieve these savings through three primary offerings; e-Prior Authorization, Specialty Oncology Case Review and Cancer Care Insights and Analytics.

e-Prior Authorization

Oncology Analytics e-Prior Authorization platform, is purpose built for oncology to efficiently evaluate and approve high-quality and high-value treatments for cancer care.
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Specialty Oncology Case Review

For complex and complicated patient cases, peer-to-peer reviews are facilitated by our Clinical Team, which may include in depth reviews by our Distinguished Academic Advisory Board.
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Cancer Care Insights & Analytics

Oncology Analytics offers deep insights and analytics for health plans and providers, which can aid in the further development and improvement of cancer care.
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e-Prior Authorization

Oncology Analytics e-Prior Authorization platform, is purpose built for oncology to efficiently evaluate and approve high-quality and high-value treatments for cancer care.

The platform is updated daily to accurately reflect more than 6,000 oncology treatment protocols for anti-cancer treatment across all cancer types and stages, including chemotherapy, radiation therapy, precision medicine, targeted therapy and supportive care.

Using a simple user interface, treating physicians enter their treatment recommendation and will receive an automatic authorization if their request is within recognized guidelines. Treatments requested that are outside of the guidelines receive further review from the Oncology Analytics Clinical Team. The Clinical Team then collaborates with the physicians to ensure that the treatment is optimized to the individual patient.

90% of treatment requests are approved automatically or with limited follow up.

All treatment protocols contained within the e-Prior Authorization platform are reviewed and scored by our Clinical Team for efficacy, toxicity and affordability. As new indications for treatment are approved by the FDA or new cancer research is published, they are immediately entered into the system.

Oncology Analytics has proven that evidence-based medicine works in the delivery of efficacious and affordable cancer care.

Otis Brawley, MD
Chief Medical & Scientific Officer, Executive VP, American Cancer Society

Specialty Oncology Case Review

For complex patient cases, peer-to-peer reviews are facilitated by our Clinical Team, which may include in depth reviews by our Distinguished Academic Advisory Board.

When it comes to patient care, we recognize that sometimes costly treatments represent the best quality of care. However, often there are less costly and equally efficacious alternatives that may provide a better option for the patient. Identifying these opportunities not only reduces the cost to health plans, it may also reduce out-of-pocket costs for the patient.

The ability to dive into deep discussions and analysis during Specialty Oncology Case Reviews helps identify optimal treatment options based on each patient’s unique situation. The treating oncologist has the opportunity to discuss their patient’s case with board certified oncologists, radiation oncologists, hematologists and pharmacists.

Ensuring high-quality of care through clinical interventions with the treating provider, results in a standard path of care for the patient and a ROI for our health plan partners.

I am amazed how Oncology Analytics manages difficult cases with varying existing scientific opinions. They have proven to me that they always have the patient’s best interest in mind. I personally would like to thank OA in the name of my patient.

Izidore Lossos, MD
Oncologist, University of Miami Sylvester Cancer Center

Cancer Care Insights & Analytics

Through constant review of new and existing oncology drug therapies, their outcomes and adverse effects, Oncology Analytics offers deep insights and analytics for health plans and providers, which can aid in the further development and improvement of cancer care.

We are committed to enabling health plans with analytics and tools that help create mutually beneficial relationships with providers, through incentives that foster a commitment to evaluating treatment options from the perspectives of efficacy, toxicity and cost. This approach puts the patient in a position to achieve the best possible outcome.

A specific example of our capabilities in this area is fee schedules and normalization. Most payment methodologies encourage the utilization of high-cost drugs as reimbursement and profitability increase proportional to the rising cost of the drug. Oncology Analytics takes an alternative approach, creating incentives for caregivers to use treatment options that put efficacy first, with a better balance of cost and the patient’s experience.

Our custom fee schedules provide a comprehensive list of tailored fees used by health plans to reimburse providers for the cost of oncology-related drugs administered in the outpatient setting and billed under medical benefits. The list details fee maximums used for drug reimbursement on a fee-for-service basis. Normalizing the fee on high dollar therapy, while increasing the incentives on value-based drug utilization, helps drive best practices for value-based care and realigns financial motivations.

Further, with appropriate data use agreements and regular updates of paid claims and other critical data, Oncology Analytics is able to provide benchmarking and provider comparative analyses that give insights into our clients’ performance relative to other plans, and the performance within their provider network.

Two-thirds of men with low-risk prostate cancer are over-treated. Oncology Analytics uses the latest Epstein criteria to help urologists to decide which early-stage prostate cancer patients may be appropriate candidates for active surveillance rather than surgery or radiotherapy.

Jonathan Epstein, MD
Pathologist, Johns Hopkins Hospital