Oncology Management

AultCare’s Oncology Management Program includes a comprehensive, integrated approach to managing cancer conditions. With early detection of care coordination opportunities, evidence-based treatment plans, and our partnership with eviCore, AultCare provides quality and safety processes along with controlled costs and measurable outcomes.

eviCore empowers the improvement of care by connecting patients, providers, and health plans with intelligent, evidenced-based solutions to enable better outcomes. eviCore promotes transparent, shared decision making and ongoing education for new products and standards in the marketplace.

Identification

1. Utilizing the Prior Authorization process (Medical and/or Pharmacy). 2. Data mining from AultCare’s claims data. 3. Referrals to the AultCare Case Management team from the Primary Care Physician (PCP) or Oncologist.

Oncology Management

Process

AultCare’s Care Coordination teams reach out to members once a diagnosis is received. Utilizing evidenced-based criteria, AultCare’s clinical teams facilitate to:  Administer educational support and resources.  Reduce Emergency Department utilization.  Reduce hospital admissions.  Provide patient navigation through the complex system.

Early detection and notification promote to support:  Appropriate network adherence.  Cost control.  High-quality outcomes.

Once identified, each patient is followed on an ongoing basis through the entirety of care to ensure access to appropriate providers and treatment, as well as cost and utilization control.

Outcomes

Various metrics are reviewed as an indicator of high-quality care and cost control. Some of these metrics are: 1. Emergency Department utilization. 2. Referral destination and site-of-care. 3. Patient navigation. 4. PMPM costs.

AultCare’s Utilization Management Team