The Medical Oncology Program helps improve quality and manage costs for cancer care. The program recognizes value and enhances patient outcomes.
Importantly, the program also supports oncology practices in significant ways:
Providing actionable information
When your practice prescribes a cancer treatment regimen and submits it for review, it is compared against a comprehensive database of current, evidence-based Carelon Medical Benefits Management Cancer Treatment Pathways. In cases where the planned regimen is not aligned with an identified Pathway, information on alternatives may be presented.
Identifying Carelon Cancer Treatment Pathways
Your practice wants to ensure quality patient care. The Medical Oncology Program helps better align quality with reimbursement. By choosing designated Carelon Pathway regimens, your practice can become eligible for enhanced reimbursement. You may decide, however, that another treatment regimen is best for an individual patient. Whether a cancer treatment pathways or an alternate regimen is chosen, the Medical Oncology Program supports benefit coverage for all regimens that meet the clinical review criteria under BCNC medical policies and clinical guidelines.