The continuum in which payers are managing to evidence based care varies from:

Lack of medical policy guidance for MD-administered benefit with few restrictions on treatment to requiring

Pre-Authorization / Medical policy guidance on select high value products

Medical policy based on evidence based care guidelines (e.g. NCCN); increased authorization burden

• Increasing demand to adopting standards of care and consistently achieving adherence
• Pre-certification and prior authorization; high administrative burden
• Significant resources required for personnel,  informatics and decision-support tools
• Increased administrative burden and costs required to administer treatments and insure adequate reimbursement
• Post treatment delays in reimbursement and retrospective denials
  
  

• Standardize care and improve the overall quality of care provided to health plan members
• Understand rates of adherence to national guidelines compared to a peer group of practices
• Use technology to support data collection and adherence to standards
• Offer the services of a single vendor to streamline operations and data capture; create incentives to encourage adoption.
• New paradigms for reimbursement.

• Quality-based care
• Increasing and demonstrating value to managed care organizations
• Long term viability for the practice and community oncology
• Enhancing and maintaining profitability

• Developed locally via a consensus-driven process
• Regimen Profiler with practice fee schedules loaded for all major payer contracts
• Clear Coverage^TM- prior authorization management solution to automate requests and link directly to key payers
• Standardized care pathways for lymphoma, breast, lung and colon cancer
• Quarterly actionable practice management reports that identify opportunities for improvement

• Using accepted guidelines, the Practice adopts consensus developed care pathways
• Practices uses FCCN clinical and financial tools to implement standardized regimens for lymphoma, colon, breast, lung cancers
• Practice/FCCN monitors compliance with standardized care pathways

FCCN prepares quarterly benchmark reports on:

• Utilization
• Adherence
• Cost
• Reimbursement

• Quarterly calls are provided to review the reports and discuss opportunities for improvement

• Alternative reimbursement models
• Treatment planning fees and episodes of care models for reimbursement
• Decreased prior authorization requirements
• Enhanced reimbursement for guideline compliance leading to an alignment of incentives between practices and payers
• Expertise to ensure successful payer contract negotiations on behalf of FCCN practices

• IT
• EMR
• Clinical Pathways and Practice Guidelines
• Regimen Standardization
• Guideline Compliance

• Regimen Selection/Clinical Pathways/Practice Guidelines
• Preauthorization/Utilization Management with Efficient Compliance Monitoring
• Compehensive Software Solutions That Integrate with Existing Practice Management Systems and EMR's to Achieve Efficiences for the Practice
• Care Management Programs
• Quality Indicators
• Supportive Care Monitoring
• End of Life Management
• Web based Access to Single Point of Care Patient Assistance Programs, Co-pay Assistance  and Drug Replacement