The Lynx Group

eviti: Decision Support at the Point of Care for Oncologists

May 2012, Vol 3, No 3
Arlene A. Forastiere, MD
Senior Vice President, Medical Affairs
eviti, Inc
Philadelphia, PA

An independent health information technology company, eviti, Inc, provides a suite of web-based decision-support services that connects and delivers value to all parties in the care process—patients receive quality care, physicians are assured payment, insurers pay for quality care only, and pharmacy benefit managers (PBMs) or specialty pharmacy improve adherence. This decision support platform is a transformative solution that reduces variability in care, improves quality, and enables realignment of provider incentives.

Introduced in October 2010, the eviti platform ensures that evidence-based treatments are prescribed, followed, and appropriately reimbursed. Developed for use at the point of care, eviti supports physicians in the prescription of evidence-based treatment that is compliant with payer plan language and that automates the preauthorization process, thereby eliminating costly retrospective claims review that cannot improve patient outcomes or quality.

eviti is an innovative and collaborative approach that promotes quality oncology practice to benefit all parties in the care process. As of April 1, 2012, close to 1500 oncology practices are registered users of eviti.

The company has evolved its services in oncology over nearly a decade. Initially providing telephonic specialized oncology case management to covered members of client payer organizations, we saw that 32% to 41% of prescribed treatments did not meet nationally recognized evidence-based standards, which is consistent with reporting by others.1,2 As a result, we added a treatment plan review service by working with more than 4500 oncologists and a wide range of payers. Although these services delivered significant savings to clients, we recognized that much greater value could be achieved by connecting all parties at the point of care, which led to the launch of the eviti decision-support solution.

Treatment Decision Support

At the point of care, eviti’s decision support empowers physicians with all evidence-based treatment options and electronically connects physicians with payers in real time. Using this platform, physicians are ensured of payment, and insurers receive transparency of risk and know that they are paying for quality treatment.

To achieve this, eviti supports physician decision-making with the most comprehensive and unbiased single information source of available cancer treatments for all cancer types (>120, including pediatric cancers); more than 1200 systemic therapy regimens plus radiation therapy treatments; and, since January 2012, more than 9000 registered clinical trials.

Each evidence-based regimen entry contains granular details of the appropriate treatments (ie, surgery, radiation therapy, and systemic therapies, such as chemotherapy and hormonal therapy, and stem-cell transplant), stratified by specific pathology and by cancer stage, data on the resulting clinical outcome and toxicities, and levels of medical evidence and endorsement within the oncology community.

Regimens are added or revised based on multiple data sources, including peer-reviewed journal publications of clinical trial results, government sources (ie, US Food and Drug Administration, National Cancer Institute), oncology professional organizations (eg, American Society of Clinical Oncology, American Society of Hematology, and American Society of Therapeutic Radiology), and other recognized guideline standards groups, such as the National Comprehensive Cancer Network.

A library of evidence-based medicine is kept current by a dedicated team of full-time oncologists, oncology-certified nurses, and a director of clinical informatics, along with oversight from the company’s medical advisory board composed of nationally recognized leaders in oncology. eviti identifies all clinical trials for which a patient may qualify, to facilitate physician–patient discussions of investigational treatment options and to reduce the use of ineffective therapies.

How It Works

Upon input of the diagnosis, clinical characteristics, relevant molecular markers, line of treatment, and treatment intent, eviti identifies and displays all evidence-based treatment options and indicates those that are compliant with a payer plan language for oncology reimbursement decisions. The regimen details of drug, dose, schedule, and appropriate supportive-care drugs are shown. For each regimen, the literature reference and endorsing entities are provided, along with the regimen cost (average sales price plus 6%), outcomes, and toxicity.

Once an evidence-based treatment that is consistent with the health plan benefits is selected, an eviti code is generated, with a simultaneous electronic notification to the physician, payer, and PBM or specialty pharmacy if approved by the payer. The eviti code assures the oncologist of payment, and confirms for the insurer that quality care is prescribed. Real-time preauthorization is transmitted to the PBM to facilitate shipment of the drug.

An eviti provider dashboard allows real-time tracking of treatment plans and assigned eviti codes. At the moment of prescribing, the eviti payer dashboard enables payers to see treatment details, costs, and efficacy. However, as practicing oncologists know, all treatment authorization cannot always be automated. Approximately 10% of prescribed treatments will vary from evidence-based medicine for reasons justified by patient-specific clinical information.

How eviti Delivers Value

eviti is a front-end solution to ensure that the right care is prescribed before treatment begins. Its value is not dependent on retrospective review or dictating treatment to the physician. Of note, eviti is configured for integration into any electronic health record system, and as noted, it is free to physicians. Since becoming commercially available, eviti has reduced the rate of noncompliance with nationally accepted standards of care from a range of 32% to 41%, to 9%. This 72% reduction in treatment plan deviation translates into a cost avoidance of $12.4 million annually to payers (and lower copay for patients), which can be realized for every 1 million covered lives.

Automated review reduces payer administrative and claims processing costs, while ensuring consistency, quality treatment, and appropriate reimbursement. Expert peer-to-peer conversations help eviti staff to advocate for reimbursement of high-quality care for medically justified variances or deviations from payer plan language.

A platform for promoting variable pay-for-performance arrangements, eviti can protect and enhance physician income, while promoting high-quality, cost-effective care. This approach supports practices to maintain economic viability within the framework of any of several compensation models that aim to control costs (eg, bundling, accountable care organizations, pay for performance).

References

  1. Harlan LC, Greene AL, Clegg LX, et al. Insurance status and the use of guideline therapy in the treatment of selected cancers. J Clin Oncol. 2005;23:9079-9088.
  2. Wu X-C, Lund MJ, Kimmick GG, et al. Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol. 2012;30:142-150.

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