Optum process through the cancer journey
Flowchart graphic shows 7 steps in the cancer journey:
- Step 1 is pre-diagnosis
- Step 2 is cancer diagnosis
- Step 3 is treatment decision
- Step 4 is active treatment
- Step 5 is remission
- Step 6 is recurrence
- Step 7 is end of life
Between steps 2 and 4 are treatment protocol change, and between steps 2 and 6 are cancer recurrence.
Optum programs support each step in the journey:
- During steps 2–3, Cancer Resource Services helps members access in-person and second opinions at cancer Centers of Excellence (COE) at a discounted rate.
- During step 3, the Cancer Guidance Program offers prior authorization and UM for medical oncology and radiation oncology using clinical evidence, site of care, dosage and more to guide providers to the best treatment.
- During steps 4–7, the Cancer Support Program provides comprehensive support for members going through cancer treatment, which helps reduce inpatient utilization, ER visits and unnecessary end-of-life treatments.
- Throughout every step, we offer value-based care (VBC) and in-market clinicians (new). We employ clinicians to build relationships with providers and move them to VBC P4P or shared risk arrangements, enhancing our ability to take oncology risk.
Check out our oncology solutions
Cancer Resource Services
Cancer Resource Services (CRS) provides access to top-performing cancer centers across the country, known as our Cancer Centers of Excellence (COE) network. CRS is particularly useful for individuals seeking a second opinion on their cancer diagnosis or treatment.
The network includes 39 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
Results:
- 50,000+ members supported since 20019
- Plans save on average $25,000 each time they use an Optum COE9
Cancer Guidance Program
The Cancer Guidance Program (CGP) is a utilization management service for oncology treatments. It leverages technology and appropriate clinical intervention from oncology clinicians to ensure members receive high-quality medical care at lower costs.
It reviews use of both medical oncology and radiation oncology treatments. See available oncology pathways. CGP supports 31 million members across multiple clients. The program has 7 case studies demonstrating a 4:1+ ROI.7
Results:
- 85% of requests entered by provider through CGP website (time frame: 2022–2023)8
- 96% preferred product adherence (time frame: 2022–2023)8
- 20% adherence in pathway adoption (time frame: 2022–2023)8
The Specialty Guidance Program (SGP) and CGP are closely connected. CGP focuses on cancer conditions, while SGP focuses on specialty non-cancer conditions.
Cancer Support Program
The Optum® Cancer Support Program (CSP) is an integrated approach that closes gaps in care. Members have access to a specialized nurse case manager and support from a team of cancer experts.
CSP nurse case managers provide network guidance, education, pain management, treatment adherence, and 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 the total cost of care for clients.
- Participant Net Promoter Score® of 725
- Cancer Support Program is used to support of 21 million+ members across multiple clients6
Value-based care
Optum Health experts will work with providers to implement incentives for quality initiatives and evidence-based clinical pathway adherence.
By supporting providers in practice transformation and performance reporting analytics, both the quality of care and the value of cancer care will improve.
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Complementary solutions
Optum Oncology Pathways
Specialty Pharma Solutions
NurseLine Services
Complex care management
- National Center for Chronic Disease Prevention and Health Promotion. Health and economic costs of chronic diseases. March 2023. Accessed April 2023.
- Optum Health Solutions analysis from updates posted on FDA website, 2022.
- National Cancer Institute. Cancer statistics. Last updated April 27, 2018. Accessed January 2023.
- 2023 Optum book of business analysis.
- NPS: OHS Oncology team, 2022.
- OHS Oncology team, as of Dec. 2022. 7 Case Studies: based on OHS Oncology and/or Client Analytics analysis and validated by clients, as of Dec. 2022.
- Ibid.
- 2023 OHS Oncology Analytics as provided through PowerBI / Tableau.
- OHS Oncology analysis based on client book of business, 2022.