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Transcript – eviti Presentation
“I recently got a call from a friend who called to tell me that a colleague of his had just been diagnosed with cancer. We all have gotten these kind of calls – I think they affect all of us in the same way. Immediately we’re connected to the fear and anxiety that goes along with a cancer diagnosis. And I could tell from the voice on the other end of the line that this friend of mine had that concern, and he called and said, can you help. And I remember him asking me specifically, and I remember what it felt like for him to ask me, can you help.
Now this is a very smart guy and he has access to all the information that any of would have, so he’s not worried about finding a good doctor. He knows how to do that. He’s not worried about doing the research to find the best cancer center in the country. He can do that too, and they know exactly where that cancer center is, and he’s obviously working closely with his colleague to find the best place to get care. He wasn’t calling me about that. He was calling me with a question that almost, probably everybody asks, somewhere in this process, and that is, am I getting the right treatment. Is this the right treatment plan?
Is that a good question to ask? It is. Because one third of all treatment plans today do not meet evidence-based standards of care. They’re inappropriate in some way. Wow, think about that. That’s not a very good game of Russian roulette, is it? One out of three? 32% of treatment plans deviate from appropriate standards of care?
So my friend was clearly aware of the fact that if we don’t get the treatment plan right from the start, we don’t give ourselves the best shot at beating cancer.
And that brings us to our presentation today. Let me tell you a little bit about why he would call me by telling you a little about who we are. And then we’ll look at the crisis in cancer care today. And there are three very distinct factors that are weighing in on and creating this crisis. And finally we’ll look at the answer, which is really the exciting part.
He basically called me because I have the extraordinary privilege of working with an extraordinary group of individuals who have set out to provide this answer – not only to my friend, but everyone who needs that answer. Terrific group of individuals with a mission that says,
eviti provides independent decision-support to help ensure evidence-based oncology care is prescribed, followed and appropriately reimbursed from the start through survivorship. A great mission. And a great mission that has to be supported by some very important words that are packed into that.
First, we have to be independent. If we’re not independent, then we’re not advising the process appropriately. We have ulterior motives. The great thing about eviti is that there is zero financial interest in the treatment plan selection process – none!
It’s evidence-based; it’s not our pathways. Who are we? No, its a collection of all the appropriate, evidence-based treatment options that are available for an oncologist to see at the point of treatment selection.
And its not just the prescription process that we care about. That’s good – to provide a pathway for an oncologist at the beginning is good, but what about making sure that its followed appropriately, and ultimately making sure that that provider is reimbursed appropriately, for making that decision and using evidence-based medicine.
Now add to that expert staff of oncologists, oncology nurses, actuaries, insurance professionals, software experts and engineers, and a medical advisory board that stretches from Harvard to Cedar Sinai. A dozen of some of the leading oncologists in the nation have come together and said, this is an initiative that I want to be a part of. This is something I want to get behind.
We’re URAC accredited. For those of you who are aware, this is an extraordinary process to go through, and its a very important one for establishing the credibility of an organization. I think one of the biggest contributors for the past decade. . . we’ve been working directly with patients who are in the process of receiving care through our advanced case management – oncology specialty case management services. And the insight that we’ve gotten through those years has been very valuable in building the solution that we’re going to talk about.
In addition, we work with over 4,000 oncologists – almost a third of all the oncologists in the country. So that insight, that experience, has helped us to build what is the heart of our solution, and really the heart of our company, which is this digitized, evidence-based library. We’re going to talk about that when we get to the answer.
But first, let’s take a look at the crisis in a little more detail. I want to start with a few numbers that I think you’re going to find surprising.
The first is that a full 15% of diagnoses are incorrect. How would you like to discover that you had gone through a course of chemotherapy only to discover that the diagnosis was wrong.
I mentioned this number to you earlier, but 32% of treatment plans deviate from guidelines. Now we’re going to stay on this number throughout the rest of this presentation because its an important one. Getting the treatment plan right from the start affects everything else that happens.
45% of patients do not comply with prescribed treatments. Can you imagine being diagnosed with a critical, life-threatening disease and then not being able to tolerate the medication? Not being able to stay on the treatment plan because maybe its right, maybe its wrong, maybe you just aren’t aware of all the implications of staying on this treatment plan.
50-75% of cancer treatments include off-label drug use.
We have an aging population. The baby boomers are getting older, and the older the population, the greater chance of cancer.
We have a looming oncologist shortage.
How about the new health care law? Under the new health care law, there are no preexisting conditions. There are no lifetime maximums. Now clinical trials are going to be covered under insurance and we’re going to add to the system 32 million new lives. Wow! What kind of an impact is this going to have on your business? Are you starting to see why we call this a crisis?
And there is no transparency today. Oncologists and payers are all trying to do the right thing, but there is really no transparency into each other’s business. Its very difficult to see how we can get to the right answer if we’re not collaborative, if we’re not aligned.
Remember this number – 32% – we’re going to come back to this. 32% of treatment plans are incorrect. The cost of one cancer case today is $135,000. That’s the average cost – twice as much as it was a few years ago.
What impact will personalized medicine have on this crisis? Well, personalized medicine will help pinpoint the disease and pinpoint the medication for that disease. Its going to have a dramatic impact on the decision making process for oncologists. Just a few years ago, in the 80′s, oncologists had to make just a few decisions in determining a treatment plan for a cancer patient. Today its in the hundreds, and soon, with personalized medicine, it will be a thousand decisions that an oncologist has to make just to get the treatment plan right for the patient.
Now today, we already see that the amount of information coming out and available to oncologists is far outpacing their cognitive abilities to keep up. They can’t read enough journals fast enough. They can’t attend enough conferences quickly enough. They can’t talk to enough drug reps. The information is just coming too fast.
Let’s visit this number again – 32%. Because that is the number that when my extraordinary team of colleagues begins to look at where do we start, we said, let’s start there. Let’s start with the 32% of treatment plans that are incorrect. Because we know the impact of each one of those treatment plans, and we know that if we get them right, we’ll effect cost, we’ll effect quality of life, and improve the efficiency of the provider, providing the care.
And so we said, what should be the goal. What percent of wrong treatment is acceptable? And if I asked you the same question, I hope the number that comes to mind is zero. That should be our goal. Can we eliminate the number of wrong treatment plans from the start and give ourselves a better chance of providing the right kind of care for patients?
So that leads us to discussing the answer. How can we expect to get an answer as complex as this one in a crisis as huge as the one we just described if we don’t involve everyone who needs to be at the table for this?
Its not enough to just talk to our payer clients and say what should we do. Its not enough to get the advice of our own oncologist-driven organization and say what should we do. We have to have researchers at the table. And if we didn’t bring in the experience that we’ve learned from all of these interactions with patients over the years, we would be very remiss.
So we took all of these groups and basically brought them together; figuratively, but through a collaborative, iterative process, to learn what is it that would lead to the answer that we need for this problem? And the answer became pretty clear. And it boiled down into these six points:
First, the answer has to be transparent and independent. We can’t have ulterior motives influencing this decision process.
It has to be comprehensive. We can’t ask an oncologist to make a decision and use the tool like this for lung, breast cancer and colo-rectal cancer, which although it makes up half of the cancers out there, its not enough. What about the rest of them? You can’t ask them to use a tool that only involves a half-dozen, or twenty, thirty, forty, or fifty protocols or pathways. It has to be comprehensive. It has to cover all modalities of care. It has to be credible. Who is the organization behind it? Where’s the data coming from? And can I see where the source of that data is coming from?
And no more looking back. No longer can we expect to get real change by saying, how did we do in the past. If we’re going to really change this, we have to be at the front where the decision is being made. This has to be a proactive tool.
And we have to make it accessible to everyone. We can’t say, as my friend was trying to find the right answer, today, must of us would do what? We would try to find the biggest brand name, hospital and facilities, we can find, right? The ones that have the best reputations for cancer, which means that I would expect to get better care there than I might at a community hospital.
But what if we made this tool accessible all across the population of oncologists so that everyone had access to this?
And finally, it had to be interconnected. Everyone has to have a say in the process. Everyone who has a stake in this needs to have a say in the process.
The result was the fact that we were looking for evidence-based, treatment intelligence, which bring us to the product that we’re going to talk about today called eviti. eviti is this answer, and at the heart of eviti is a clinical library. And that clinical library contains the information and the algorithms and the information necessary to deliver that information to the oncologist when he or she needs it.
And its built from journals, scientific literature – ASCO, ASH, ASTRO, ACR, Clinical Trials, NCI, FDA, NCCN. So we basically have said we need all the information that’s available that an oncologist would go look for to make this decision.
And we compiled it using clinical content experts, a medical advisory board, clinical librarians, oncologists, actuaries, oncology certified nurses, insurance professionals and informatics experts – all part of eviti, dedicated to solving this crisis and bringing a real answer.
The result is that this library now has over 120 cancer types, 1000 evidence-based treatments, with outcomes and toxicities.
It takes into account payer plan language. It includes all treatment modalities, and includes estimated costs by regimen and drug.
It is the most comprehensive, commercially available, digitized, oncology decision-support engine anywhere. That’s why its at the heart of what we’re doing.
So let me tell you a little bit about how eviti works, and how it benefits and is used by providers and payers. When a patient and a provider are determining what is the best treatment plan for that patient, the provider and/or his nurses can access eviti via any browser. They’ll enter the patient’s information, including the diagnosis, and eviti will provide them with a list of evidence-based treatment options and the literature that supports those.
The oncologist, then can determine which of those is most appropriate for that patient. And once he or she has made that selection, an eviti code is assigned and the payer is notified and gets transparency into the cost, the timing, the treatment plan for this patient.
Let’s take a look at how it works from the perspective of the software – let me show you a little bit about the software itself. As I mentioned, it is accessed via the internet. You can even use an iPad to get to it. And once the oncologist has logged on, there are three steps to getting to an appropriate treatment: Select a patient; enter the diagnosis, and enter the treatment. We also provide integration with the payer eligibility files to make sure that at that point of prescription, the physician has all the information they need to know from the payer’s perspective.
A wizard then guides the user to collect all necessary variables for any of the over 120 possible cancer types. They have a guidance system, or a wizard, that helps them stay within the bounds of evidence-based medicine, but it still gives them a lot of latitude, so they have flexibility, a fast system so that they can do it quickly, and at the end, once the line of treatment and the treatment goal are selected, then eviti presents the user with the list of nationally accepted treatment options that are also compliant with the patient’s plan language. And you can see that these are listed as compliant. If there were other appropriate treatment plans that were not covered under the plan language, they present also. So the oncologist knows that he or she has the complete list of all the appropriate treatment options.
What’s not shown here, but is also presented as part of eviti, are the costs, efficacy, and toxicity, so that now the oncologist and the patient truly have all the information they need to make an appropriate selection. Once the treatment regimen is selected, the wizard again makes it easy to complete the treatment plan and steps them through each step. And each field has the parameters so that the oncologist can make selections within the range that falls within the appropriate guidelines for this. If at any time, the oncologist doesn’t see the information he or she needs to enter in for the treatment plan, another button allows them to enter their own treatment plan. eviti, our medical advisory board, and our staff can review it, and provide a quick turn-around on an answer for that.
Within minutes, the oncologist has a completed treatment plan that can be printed or posted to an EHR. An eviti code assures the Payer, the Provider, and the Patient that an appropriate treatment plan was selected. It’s important to note, this eviti code is way beyond a typical authorization code because the eviti code is more like a bar code. It contains all the information packed into that treatment plan – CPT codes, ICD-9 Codes, J-Codes, the treatment plan itself, is all part of that eviti code, and so now everyone is aware of what’s being prescribed for this patient.
Now that you’ve seen eviti, it brings us to this question. Now. . . why give cancer an unfair advantage? If you’ll remember back to the story of my friend calling me to ask if I would help him, knowing who I was with and this great organization, he is really asking, can we help him. He’s asking can eviti help him. Because he knows that today the options are really limited. He doesn’t wan to go to a place where they’re using a system that has a few pathways or a few cancer types. He wants a comprehensive answer to this. Cancer requires a comprehensive solution. He doesn’t want to find out next month the treatment plan was wrong, but it won’t happen next time. He wants to know now for his friend. He wants this in real time. He wants to know now that the treatment plan is appropriate. He wants to make sure that the whole care process is not uncoordinated, but that its aligned, that the patients interest and the expertise of that oncologist, and really the financial implications from the payer are all factored in and aligned in the decision process. He certainly doesn’t want his friend going through the wrong treatment plan which is wasteful to both the patient and wasteful to the payer. He wants a cost-effective solution – the best care at the right and appropriate cost. You see, its because he doesn’t want his friend to get the wrong treatment. He wants the right treatment from the start.
We have one clear focus, and that is to make the most comprehensive oncology decision-support resource on the planet, to make it accessible by every oncologist, to treat every cancer patient in the world, because every time eviti is used, it reduces that 32% to zero.
Thank you.
