Payers

Cancer Care Validation for Payers

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Transcript – Payer Introduction

Eduardo Beruff, CEO & President, eviti, Inc. “The advantage of eviti to payers is that for the first time in history they have all of the treatment information they need to analyze and reimburse for before treatment begins. They can understand and manage their cancer risk in ways that they’ve never been able to do so before. Currently, claims information comes in but it is disconnected from the underlying clinical condition and the treatment itself. Payers are paying after the fact without knowing whether or not that treatment is appropriate. And in cancer right now, fully one third of all treatment deviates from guidelines. So eviti provides the decision support that delivers the assurance that the right care has been prescribed.”

Susan Spalding, Senior Vice President, eviti, Inc. “It’s an important tool for payers because it gives them complete transparency both clinically and financially, so that they can manage their business on an individual basis or on an aggregate basis. And with unlimited lifetime maximums, it’s going to be very important for these organizations to understand what their total liability is. eviti not only gives them the transparency to understand the quality of treatment, they get all the data points that they need in order to manage that claim, so they’re getting the J-Codes, billable units, AWP pricing. They have both pricing on an individual cycle basis, and on an aggregate basis for the potential cost of the total claim.”

Robert Comis, MD, Chairman, eviti, Inc. “The insurers benefit in the sense that they are made aware of what the best approaches are for their patients, and in the end, they are interested in delivering the best care that a patient can get. That’s the only way that an insurance company will have the credibility and credence to survive.”