National partnership improves patient experience and eases administrative burdens on provider practices
NCH Management Systems, Inc., D/B/A New Century Health (NCH), a national leader in specialty care management, and Humana Inc. (NYSE: HUM) are celebrating one decade of a national partnership to improve the patient experience, reduce the financial burden to patients, and ease administrative burdens on provider practices.
“We are living through an era of ongoing change in oncology care,” said Bryan Loy, MD, Humana Corporate Medical Director. “While the rapid growth of new cancer drugs and tests has brought hope to patients and providers, it also presents oncologists with ever more complex decisions about which regimens will offer the best care. For a decade, New Century Health has been a credible resource to help Humana members’ providers with those decisions, without burdening them or delaying care.”
_q_tweetable:"Prior authorization in oncology has long been synonymous with extra paperwork, interruptions to providers’ clinic time, and conversations with non-oncologists to justify a requested treatment. This program has reengineered that system to be focused on quality, efficiency, and convenience."_q_
Humana and New Century Health have designed a sophisticated, technology-enabled oncology management program across Medicare Advantage, Commercial and Medicaid populations, which today serves nearly 3.6 million Humana members across 35 states. At the core of the program are New Century Health’s high-value clinical pathways. Developed and continuously refined over the past 20 years by New Century Health oncology experts and vetted by independent scientific advisory boards in both medical and radiation oncology, these pathways guide providers to select the most effective and least toxic regimens for each patient. When multiple regimens are equivalent, the pathways educate providers about high-value options that reduce the financial burden on patients. Across the Humana network of more than 10,000 oncologists, nearly 100% of cancer regimens follow strict National Comprehensive Cancer Network guidelines, with roughly 75% of those meeting New Century Health's highest tier pathways.
In addition, pathways make the prior authorization process—widely understood as a dis-satisfier for providers and patients—almost invisible. Nearly 50% of all requests submitted by Humana network providers via New Century Health’s digital decision-support platform receive automatic, immediate authorization, dramatically reducing the administrative burden on practices and reducing delays in care. Analytics, performance incentives, and a dedicated team of population health resources help ensure an ongoing, collaborative relationship with network providers.
“Prior authorization in oncology has long been synonymous with extra paperwork, interruptions to providers’ clinic time, and conversations with non-oncologists to justify a requested treatment,” said Dr. Samir Mukundray Dalia, a Humana network provider, and an oncologist-hematologist with Mercy. “This program has reengineered that system to be focused on quality, efficiency, and convenience. Our providers often receive instant electronic authorization for entire courses of care—not just single regimens. Even in those cases that require further review, we have true peer-to-peer discussions with NCH oncologists that are collegial, evidence-based, and singularly focused on achieving the best care for the patient.”
In a partnership marked by continuous innovation, other achievements include:
Improving patient quality of life. In 2020, about 45% of all peer-to-peer collaborations between New Century Health oncology experts and Humana providers resulted in revised, higher-quality regimens.
Reducing drug waste and financial burden. Many cancer drugs come as single-use vials that cost the same regardless of whether 1% or 100% of the contents are administered. In March 2021, Humana and New Century Health launched a program to encourage providers to optimize ordered doses to match the nearest vial size—an industry-approved practice that reduces waste while maintaining high-quality efficacy standards. One in every five cancer patients has out-of-pocket costs that are $20,000 or more each year, but this step can help ease the burden for some.
“We’re honored that Humana has entrusted New Century Health over the past decade with the sacred responsibility of ensuring the highest quality care for hundreds of thousands of its members living with cancer,” said Dan McCarthy, chief executive officer of New Century Health. “Throughout these last 10 years, the oncology field has moved at a breathtaking pace, and all signs point to the innovation curve further steepening in the years ahead. We look forward to partnering with Humana in even deeper ways to continue leading the way in value-based cancer care, motivated by our mission to align care plans with the latest scientific evidence and patient goals of care.”
About New Century Health
New Century Health is the nation's leading specialty care management company, with special focus on cancer and cardiology patients. New Century Health partners with specialty providers and health plans to provide them with clinical decision and population health management tools to ensure that cancer and cardiology patients receive the highest quality, most affordable care. New Century Health has been URAC-accredited in Health Utilization Management since 2011 and received NCQA accreditation in Utilization Management in June 2020. New Century Health is a wholly owned subsidiary of Evolent Health. To learn more about New Century Health and its technology and services oncology solution described here, please visit newcenturyhealth.com.
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.
More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com.