Growing need to manage costs of cancer care and to identify highest quality treatments
A $240 billion global spend on oncology therapies and supportive care drugs is projected by 2023. There were 43 new drug indications across 42 cancer types and 13 new drug types launched from January 2019 through April 2020. Diagnoses are on the rise as 38.4% of Americans will be diagnosed with cancer in their lifetimes and require life-saving treatments. Medical knowledge doubles every 73 days.OR
Improve patient experience, outcomes and costs
The Optum Cancer Support Program, Cancer Resource Services and Cancer Guidance Program support members through diagnosis, referral, treatment and ongoing care.OR
We have over 15 years of experience in oncology utilization management and process more than 200,000 authorizations annually.
Cancer Support Program
The Optum Cancer Support Program (CSP) is an integrated approach that closes gaps in care. With CSP, members have access to a specialized nurse case manager and support from an entire team of cancer experts.
CSP nurse case managers provide network guidance, education, pain management, treatment adherence, palliative and end-of-life care.
Ensuring the patient’s condition is properly managed helps avoid hospitalizations, emergency department visits and inappropriate treatment, thus reducing total cost of care for clients.
Cancer Support Program
The Optum specialized case manager helps Nancy receive proper treatment.
Cancer Resource Services
Cancer Resource Services (CRS) provide access to top-performing cancer centers across the country, known as our Cancer Centers of Excellence (COE) network.
The Optum COE network includes 37 leading cancer centers that meet strict evaluation criteria such as:
- A multidisciplinary approach to care
- Program depth and breadth
- Best-practices medicine
- Patient- and family-oriented programs and services
- Patient volumes
- Treatment planning and coordination
- High-quality clinical research
- Patient safety
Cancer Guidance Program
The Cancer Guidance Program (CGP) is an evidence-based cancer treatment, utilization management and analytics service. CGP helps reduce medical expenses associated with a range of high-cost, complex cancer treatments.
CGP supports providers serving over 24 million members across multiple clients. It generates more than a 10:1 ROI by mitigating cost trend,5 even before implementing value levers such as Pathways and Preferred Products.
Online prior authorization portal and guideline library
- CGP website recommends patient-specific treatment plan options to providers on over 97% of cancers and 2,100 regimens
- Based on guidelines from nationally recognized third parties including National Comprehensive Care Network (NCCN)
- Encourages providers to select from Optum pathways across 18 cancer types developed by a team of oncology experts from academic institutions and community settings
- Innovative program that enables clients to deploy unique strategies for managing oncology drug spend through value levers such as Preferred Products to Dosage Management
- 22+ million lives of clinical and claims data identify quality and cost outcomes disparities to inform pathways and drive affordability opportunities beyond prior authorization
- Provider Net Promoter Score: 62
- 79% of requests entered by provider through CGP website
- 50%+ shift in preferred product adoption
The Specialty Guidance Program (SGP) and CGP are part of the Specialty Medical Guidance Program family. CGP focuses on cancer conditions, while SGP focuses on specialty non-cancer conditions.
More ways we help
- IQVIA. Global oncology trends 2019. Iqvia.com/-/media/iqvia/pdfs/institute-reports/global-oncology-trends-2019.pdf. May, 2019. Accessed April 27, 2020.
- U.S. Food and Drug Administration. Hematology/oncology (cancer) approvals and safety notifications. fda.gov/drugs/resources-information-approved-drugs/hematologyoncology-cancer-approvals-safety-notifications. Last updated April 22, 2020. Accessed April 27, 2020.
- National Cancer Institute. Cancer statistics. cancer.gov/about-cancer/understanding/statistics. Last updated April 27, 2018. Accessed April 27, 2020.
- 2019–2020 Optum book of business analysis.
- Optum book of business, Nov. 2018–Aug. 2019, for Medicaid client with membership across 11 states.
- Optum book of business, June 2020.