Case Study

GEHA sees lower costs

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Transcript – Case Study

Kathy Ross, GEHA Manager of Care Management. “Most health plans are on a quest, looking for something to manage the whole cancer space. We made the decision that with a 40% noncompliance rate, we were going to start looking for companies external to us to bring expertise. We want to be an organization that bases our care; bases our decisions on evidence. Anyone who gets a cancer diagnosis wants something done right then and there. They don’t want to have to go through a laborious process of getting things approved.

Jenny Brown, eviti Clinical Account Manager, eviti, Inc. “eviti helps physicians determine the best treatment for the patient; making sure that the patient is getting the standard of care, evidence-based medicine for their treatment. It is not trying to dictate their treatment; it is simply just giving them all of the options – over 1,000 treatment regimens for over 100 different types of cancer. And it narrows it down to all the treatments that are appropriate for that patient – the cost of each cycle, the cost of all the cycles together, each drug, toxicities and all the different clinical trials.

Kathy Ross, GEHA Manager of Care Management. “There really wasn’t anything like eviti which is web-based and independent. You can also load your plan benefits into eviti, so that your plan language then draws a provider to choose something that they know is either on formulary, or the evidence is very strong for one over the other. There is cost information in there, so that the provider could use that and could also know that this would be covered by a certain health plan.

“It allowed us to take a look at the treatment plan before it was started, and if it was out of guideline, an opportunity to reach out to that provider and influence them towards an evidence-based guideline. And that really has been key. Non-compliance rate has gone from 40% down to 9%. We have some assurance that people are also getting the right treatment.”

Jenny Brown, eviti Clinical Account Manager, eviti, Inc. “GEHA uses eviti and now that they can see on every single patient what the treatment is, and everything associated with that treatment, and they know that the member is getting the best treatment possible.”

Kathy Ross, GEHA Manager of Care Management. “Once they have chosen an appropriate cancer treatment, they receive an eviti code, and that eviti code then prompts all of that information to show up on the dashboard. The dashboard is just full of great information about all of that authorization that has happened.

“With our PBM, it is really important for all of this authorization process to be transparent. As with most health plans you work in two different systems – they have their system, you have your system. But the dashboard transcends both of those. Its really a benefit for them to see that real time.

“PBM is responsible for making sure that the drugs get dispensed to that member and make decisions about dispensing the medication, but more importantly, knowing that the authorization is there and not holding things up.

Jenny Brown, eviti Clinical Account Manager, eviti, Inc. “GEHA and the payers can utilize the dashboard to get all this information on their patient in relation to what the treatment is and the cost associated with those treatments. And they have peace of mind that their members are getting the best treatment.

Kathy Ross, GEHA Manager of Care Management. “Most health plans are looking at those key things: how is this going to affect my provider community; is it going to reduce our costs; is it going to in any way disrupt that patient/provider relationship; and is it going to be good for our patients. Those would be the four things I think most health plans are looking for, and eviti is sort of pivotal in all of those four areas. That’s really the good news for health plans.”