8/27/2012 Quality health plans & benefits Healthier living Financial well ‐ being Intelligent solutions A differentiated strategy for cancer care David Epstein, MD August 27, 2012 We put people at the center of everything we do This presentation outlines how we can help members and providers optimize cancer care 2 Aetna Inc. 1
8/27/2012 A new strategy for cancer care Today we are going to: • Share current thinking of cancer care • Discuss why we need a new strategy • Propose a new strategy for cancer care to: ─ improve care for members with cancer ─ drive use of evidenced ‐ based medicine through the use of a clinical decision support platform that provides administrative simplification ─ integrate and coordinate all components of cancer care to drive meaningful change in member’s and provider’s approach to cancer care ─ articulate a clear, powerful message to the market on Aetna’s unique approach to cancer 3 Aetna Inc. Cancer is the most costly medical item and increasing at 2 ‐ 3x the rate of other costs $55 B 1000% Cumulative Annual increase percentage $123 B Cancer care Cancer drugs 20% increase is the leading Cancer medical 12 ‐ 18% Healthcare 9% edge of medical US GDP 3% 0% cost trend 1996 2010 Aetna’s top Medical Rx Inpatient Radiology Specialist Physician 30.8% 23.3% 22.4% 9.4% cost drivers in 1.5 B 1.1 B 1.1 B 483 M cancer care *2010 CY Claims; Commercial & Medicare; All Funding; Excludes AGB/SH/SRC Plan Sponsor “We want to reduce our annual healthcare costs by 15%...” “Willing to exchange access and choice for affordability…” perspective “Discounts alone are not sustainable...we need improved unit costs…” “Where do you have innovative models in place with providers that …? 4 Aetna Inc. 2
8/27/2012 Oncology marketplace dynamics impact on private practices; migration to hospital systems 172 clinics closed 323 practices struggling financially o44 practices sending ALL patients elsewhere for treatment 224 practices acquired by a hospital 102 practices merged/acquired Source: COA Practice Impact Tracking Database 5 Aetna Inc. Principles of our proposed strategy • Drive efficient use of Evidence Based Medicine ─ platform that provides content and workflows ─ integrate into the Aetna and provider systems ─ simplify the administrative processes for providers • Avoid waste and misuse of medical services ─ better provider alignment (e.g., Oncology Patient Centered Medical Home), ─ better network (narrow, tiered) ─ better decision support strategies • Leverage and integrate the many current (and future) medical and pharmacy cancer ‐ care initiatives ─ seamless, end to end cancer experience for Aetna members and providers 6 Aetna Inc. 3
8/27/2012 Optimizing quality and total cost for cancer care requires an integrated approach Medical Network management design model* Customer Plan design service Pharmacy Communi ‐ cations strategy Incentive strategy *Key differentiator is a clinical decision support platform supported by a comprehensive set of medical management programs 7 Aetna Inc. Medical management strategy Our medical management strategy has two major components: Medical Network management design model* Customer Plan design 1 2 service Communi Pharmacy ‐ cations strategy Incentive Efficient use of Evidence Leverage and strategy Based Medicine through integrate the many a clinical decision support current (and future) (CDS) platform that provides medical and content and workflows pharmacy cancer ‐ that can be integrated into care initiatives into a the Aetna and provider seamless, end to end systems and simplifies the cancer experience for administrative processes Aetna members and for providers. providers 8 Aetna Inc. 4
8/27/2012 Medical management | part 1 What are pathways? Clinical pathways are treatment roadmaps of best care practices Medical Network management design model* Customer Plan design • Developed through • Pathway lines of therapy service research and ─ Combination of drugs Communi Pharmacy ‐ cations strategy medical evidence used and the sequencing Incentive strategy of how they are given • Provide physicians a ─ Appropriateness of when more precise approach to begin treatment and to cancer care when to discontinue • Pathway treatment treatment comparison ─ A new line of therapy is ─ Efficacy generally used when a pathway did not meet ─ Toxicity (side effects) clinical outcomes or the ─ Cost (utilizing generics ) cancer progresses 9 Aetna Inc. Increased adherence to evidence based guidelines lowers cost without negatively impacting treatment efficacy Study: “Cost Effectiveness of Evidence ‐ Based Purpose: Evaluate the cost effectiveness of Treatment Guidelines for the Treatment of evidence ‐ based treatment pathways for NSCLC patients Non–Small ‐ Cell Lung Cancer in the Community Setting” Conclusion: Results of this study suggest that treating Published: Journal of Oncology Practice (ASCO patients according to evidence ‐ based guidelines is a Peer Reviewed Journal), 1/19/2010 cost ‐ effective strategy for delivering care to those with NSCLC. Source: “Cost Significantly lowered cost in the No change in overall survival Effectiveness of case group vs. The control group between the study groups Evidence ‐ Based Treatment Guidelines for the Treatment of Non–Small ‐ Cell Lung Cancer in the Community Setting”. Journal of Oncology Practice. January 2010. Volume 6. No.1. p 12 ‐ 18 Overall survival by Pathway status. 10 Aetna Inc. 5
8/27/2012 The platform for clinical decision support Easy self serve navigation for the member and the provider Provider gets Member gets Flexible clinical decision support Clinical information platform that is multi ‐ payor supportable Social media Evidence based guidelines Preferred physicians listing Network steerage preferences Culturally consistent content Online access to eligibility Data Seamless connection Precertification waived to benefit information Applications that make it easier Support services / fits their workflow 11 Aetna Inc. Level 1: Oncology Clinical Decision Support (CDS) seamlessly integrated at the point of care, to be followed by other provider facing technologies 1 Leverage Medicity’s iNexx Integrate Technologies, Study Impact of Metrics 3 2 Platform as an Oncology Develop Superior Workflows and Data Flows Informatics Exchange 1. Evidence ‐ Based Develop & Deploy CDS Office Adherence : Measure Oncology Apps on the Systems EMRs increases in adherence to iNexx Platform EBM/Aetna CPBs • Enable physician access 2. Cost Reductions : to: Compare geographically CDS similar control ‐ group o EMR practices: o order entry systems o • Therapy costs lab systems o • ER visits and inventory management systems o hospitalizations • Seamlessly exchange 3. Administrative relevant patient demographics Benefits: Survey to o Insurance information o Lab Other understand value of pre ‐ clinical information o auth automation Systems Systems consults and other physician o 4. ↑ Data Capabilities : information Sub ‐ stratify patient cohorts for future bundled payments 12 Aetna Inc. 6
8/27/2012 Level 2: Enable administrative easing of prior authorization/pre ‐ certification for practices on the platform Pended via 278 Physician 1 transaction accesses iNexx Platform Vendor vendor CDS etums/ Claims Payer ATV Processing Portal Locate CDS eviti app 5 code information Enter 6 CDS code 2 EBM Automated 3a 3b information treatment “CDS ‐ code” plan is built is delivered Oncology Email notification 4 Clinical Decision in near real ‐ time EDI Support to Aetna UM Local administrator Vendor in claims processing 270/271 Clearing transaction can be established House 13 Aetna Inc. Level 3: Develop a service ‐ oriented business, to scale as a payer ‐ agnostic solution, for providers to leverage 1, and only 1, platform Place the patient at the center of enhanced care delivery facilitated through the platform 14 Aetna Inc. 7
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