Highmark Oncology Pathways Program€¦ · Highmark’s Oncology Pathways Program. Coming Jan. 1,...
Transcript of Highmark Oncology Pathways Program€¦ · Highmark’s Oncology Pathways Program. Coming Jan. 1,...
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Highmark Oncology
Pathways Program
New Vendor Partner and Program
Enhancements Coming January 2016
Introductory presentation for
network oncologists and support
staff webinars, October 2015October 2015
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Thank you to all oncologists and support staff for your participation in
Highmark’s Oncology Pathways Program.
Coming Jan. 1, 2016
• We welcome McKesson Specialty Health as our new vendor partner
• Pathways expanding to include many more cancer sites (95% of Highmark cancer
patient volume)
• New user-friendly web-based tool: Clear Value Plus℠
• Will simplify use of foundational evidence-based clinical guidelines from NCCN
• Will help us focus on ensuring efficacy, minimizing toxicity and maximizing value
• Will provide real-time decision support, with up-to-date clinical content and integrated
patient education materials
Highmark Oncology Pathways Program
2011 -
2015
Program Background
• Program launched in 2011 to promote evidence-
based protocols, control rising costs, and support
high-quality care
• In the past four years, program options have
rapidly expanded …new opportunities to bring to
our network oncologists
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Clear Value Plus: Integrated Technology to Support Collaboration
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Clear Value Plus
• Flexible access to leading content:
• NCCN Guidelines®
• Value Pathways powered by
NCCNTM
• Provide information before treatment
decision is made
• Integrated with leading EHRs:
Epic, Varian, McKesson
• Real-time reporting & benchmarking to
assess compliance
Note: screen examples for training purposes
only; example does not reflect actual data.
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Value Pathways Powered By NCCN:Leadership In Evidence-Based Medicine
• Evidence-based protocols to reduce
unsubstantiated variability and
hospitalizations
• Refinement of the NCCN Guidelines®
• Direct collaboration with NCCN physicians
• Selected based on efficacy, toxicity and
cost
• Accessible for physicians through Clear
Value Plus technology
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Pathway Diseases…representing more than 95 percent of Highmark patient volume
• Breast Cancer
• Chronic Myelogenous Leukemia (CML)
• Colon Cancer
• Fallopian Tube Cancer
• Head and Neck Cancer(Oropharyngeal, Laryngeal, Hypopharyngeal)
• Hodgkin’s Lymphoma
• Melanoma
• Multiple Myeloma
• Non-Hodgkin's Lymphomas(DLBCL, Follicular, CLL, SLL, Mantle Cell)
• Ovarian Cancer
• Pancreatic Adenocarcinoma
• Primary Peritoneal Cancer
• Prostate Cancer
• Rectal Cancer
• Small & Non-Small Cell Lung
Cancer
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Patient Roster Home Screen
Note: screen examples for training purposes
only; example does not reflect actual data.
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Patient Treatment Decision History - Summary
Note: screen examples for training purposes
only; example does not reflect actual data.
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New Treatment Decision – Clinical Data Entry
Note: screen examples for training purposes
only; example does not reflect actual data.
Highmark
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New Treatment Decision – Treatment ‘Choice Board’ – Medical Info
Note: screen examples for training purposes
only; example does not reflect actual data.
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New Treatment Decision – Treatment ‘Choice Board’ – Financial Info
Note: screen examples for training purposes
only; example does not reflect actual data.
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Payer-Specific Content – Select Insurance
Note: screen examples for training purposes
only; example does not reflect actual data.
Highmark
Highmark
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New Treatment Decision – Treatment ‘Choice Board’ – Treatment Details
Note: screen examples for training purposes
only; example does not reflect actual data.
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New Treatment Decision – Treatment ‘Choice Board’ – Exception Process
Note: screen examples for training purposes
only; example does not reflect actual data.
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Note: screen examples for training purposes
only; example does not reflect actual data.
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Real-Time Reports: Pathways Compliance Reports
Note: screen examples for training purposes
only; example does not reflect actual data.
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Real-Time Reports: Off-Pathways Exceptions
Note: screen examples for training purposes
only; example does not reflect actual data.
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Real-Time Reports: Export Details Into Excel
Note: screen examples for training purposes
only; example does not reflect actual data.
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Implementation Roles for Success
Clinical Super Users
Business Office Super Users
System Administrator
Providers
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Key Milestones19
Milestone Note
Gather Information & Scheduling Starting Now
Set Up & Configuration** EHR integration
increases set up
work
Pre-Access Training• Admin /Super users
• Providers
Grant System Access You can use it!
Post-Access Training• Reports
• Payer Admin
Enhanced Program Go Live Jan 1, 2016
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Resources Available for Practices
For assistance, please contact your
Highmark Provider Relations
Representative
Provider Resource Center (via NaviNet®
only)
• Visit the Oncology Pathways Program page, under
the Clinical Reference Materials link. There, you will
find convenient access to the program manual,
reference guides, and more.
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Thank you for participating today.
As we transition to the enhanced program, Highmark is here to support you. Please utilize the resources on the previous
page or contact your Highmark Provider Relations Representative for assistance.
Questions?