Oncology Business Acumen

With the ever-increasing complexity of the oncology marketplace, the need for business acumen content is more important than ever to continue to understand the environment and connect with today’s customers. Oncology business acumen training provides information about the dynamic oncology-specific marketplace including oncology clinical pathways training, reimbursement, and the impact of COVID-19.


Oncology Care Model eBrief

Cancer diagnoses make up some of the most common and devastating diseases in the United States, affecting more than 1.6 million people. The Oncology Care Model (OCM) has developed an opportunity to enhance the care of these people while reducing healthcare spending. In this eBrief, we'll take a closer look at the most relevant information pertaining to the OCM, including:
- The purpose of the OCM
- Challenges in Developing the Model
- Questions account teams should consider regarding the OCM

Oncology Clinical Pathways eBrief 1: Understanding Clinical Pathways

This intermediate-level eBrief provides an advanced look at the increasingly important role of clinical pathways in oncology care, especially as more providers enter value-based payment models. It covers how both payers and providers use pathways to improve care quality and reduce costs.

Oncology Clinical Pathways eBrief 2: Developing Clinical Pathways

This intermediate-level eBrief provides an advanced look at how clinical pathways are developed. It covers the various stakeholders involved in developing pathways and what evidence they consider to be most important.

Oncology Clinical Pathways eBrief 3: Operationalizing Clinical Pathways

This intermediate-level eBrief provides an advanced look at how clinical pathways are operationalized by various stakeholders. It covers how payers and providers use electronic health records and analytics to promote greater adherence to pathways.

Oncology Utilization Management: Excluding Drugs from the Formulary

To manage utilization of cancer drugs, more pharmacy benefit managers (PBMs) and health plans are excluding drugs from their formularies. With formulary exclusions, these payers aim to limit patient access to more expensive drugs and reduce drug spending. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of excluding drugs from the formulary and why sales forces should care.

Oncology Utilization Management: Implementing Step Edits

Step edits, also known as step therapy or "fail first" policies, are the most common method used by payers to manage utilization of specialty drugs, according to a study by Health Affairs. These policies require that a patient try a payer's preferred generic or brand as the initial "step" before another brand will be covered - even if the physician recommends a different brand in the same class or category as the payer's preferred drug. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of implementing step edits or "fail first" policies and why sales forces should care.

Oncology Utilization Management: Increasing Patient Cost-Sharing and Using Tiered Formularies

To manage utilization of cancer drugs, more payers are increasing patient cost-sharing and using tiered formularies. By shifting more costs to patients, payers aim to reduce their own costs while discouraging use of more expensive therapies. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, types, and effects of cost-sharing and tiered formularies and why sales forces should care.

Oncology Utilization Management: Managing to FDA Labeling

Managing to FDA labeling is a utilization management tool used by health plans and pharmacy benefit managers (PBMs) to control the use of prescription drugs and potentially reduce costs. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of managing to FDA labeling and why sales forces should care.

Oncology Utilization Management: Optimizing the Site of Care

Patients can receive infusions of anticancer drugs in multiple settings, including hospital outpatient clinics, physician offices, standalone infusion clinics, and at home (via home infusion providers). Not all of these options cost commercial health plans the same: Hospitals tend to be the most expensive sites, compared with other settings. (That said, Medicare payments for outpatient chemotherapy do not vary much by site of care.)

Site of care optimization is an increasingly popular strategy that many commercial health plans are using to contain costs. Specifically, they are implementing policies to transition more patients from receiving infusions in hospital settings to less costly settings that are still clinically appropriate. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of optimizing the site of care and why sales forces should care.

Oncology Utilization Management: Prior Authorizations in Oncology

Prior authorizations (PAs) are a common utilization management tool used by managed care plans to control the use of prescription drugs. PAs require prescribers to get preapproval before a plan will cover, or pay for, a prescribed drug. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of prior authorizations in oncology and why sales forces should care.

Oncology Utilization Management: Setting Quantity Limits and Using Split-Fill Programs

Quantity limits and split-fill programs are utilization management tools used by payers to control the use of prescription drugs. Quantity limits, also known as supply limits, restrict the amount of a drug that a payer will cover during a specific time period. Split-fill (also known as partial-fill) programs dispense medications in half-quantities (such as a 15-day supply instead of a 30-day supply) and often target drugs with high discontinuation rates, including oral oncology products. This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of setting quantity limits and using split fill programs and why sales forces should care.

Oncology Utilization Management: Using Case Management

Case management (sometimes called care management) is a strategy to reduce costs during cancer treatment by preventing inappropriate utilization and helping patients manage their disease. This piece of the Oncology Utilization Management series includes a description of the purpose, goals and effects of using case management and why sales forces should care.

Oncology Utilization Management: Using Value Frameworks and Clinical Pathways (COMING SOON)

This piece of the Oncology Utilization Management series includes a description of the purpose, goals, and effects of using value frameworks and clinical pathways and why sales forces should care.

The Impact of COVID-19 on Your Oncology Customers

This interactive module highlights eight ways that COVID-19 has affected oncology practices, hospitals and integrated delivery networks (IDNs), and cancer patients. Specifically, it will present eight important impacts of the pandemic for sales teams to consider in their selling efforts.

The Oncology Care First Model Summary Module

This quick summary presents the most important facts about the OCF Model in a visual format. This includes graphic representations to answer the following questions:
- What are the goals of the Oncology Care First Model?
- How are oncologists paid for managing and administering drugs through the OCF model?
- Which quality measures are included in the OCF model?
- How are oncology practices preparing to participate in the OCF model?

The Oncology Care Model – Implications for Oncologists and the Industry

The Centers for Medicare & Medicaid Services' Oncology Care Model (OCM) is transforming how oncologists are paid for providing services to Medicare patients. This module explains the most relevant aspects of OCM and how they affect oncologists. This module also describes value-based selling strategies for life science companies in this changing environment.

Utilization Management in Oncology Summaries Series (COMING SOON)

This series focuses on how payers use different methods to manage oncology drugs, from “softer” tools to more restrictive strategies. There will be a summary for each topic that includes a description of the tool, how it is used, and why sales forces should care.

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