Highmark Oncology Pathways Program€¦ · Highmark’s Oncology Pathways Program. Coming Jan. 1, 2016 • We welcome McKesson Specialty Health as our new vendor partner • Pathways

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

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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7

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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14

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

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?