HealthHelp to provide radiation oncology management on national scale

With cancer’s incidence and treatment costs rising, HealthHelp has become the first company to provide radiation oncology management on a national scale. Approximately 4 million Humana patients in 46 states will benefit from this innovative new program.

Humana’s service went live in early July, one month after researchers at M.D. Anderson Cancer Center published a paper in the Journal of Clinical Oncology estimating that the number of cancer cases will rise by 45 percent over the next two decades. Another analysis—published in the same journal just as the Humana program launched—concluded that the economic burden of cancer care will continue to make it less affordable for more and more Americans unless health care organizations take steps or curb such trends.

“Controlling treatment cost and quality has become an imperative for payers,” said HealthHelp president and CEO Cherrill Farnsworth. “We are proud to serve as pioneers in the effort to keep cancer care affordable and accessible while ensuring quality and safety.”

As is the case with diagnostic imaging, radiation oncology options evolve continually as new technologies become available. While such advances often improve cancer care and save lives, overuse or misuse inflates cost and can result in subsequent illness. Meanwhile, payers and physicians face challenges in keeping up with the latest medical evidence.

HealthHelp’s radiation oncology services enable health care payers to make sure their members with cancer receive the right amounts of radiation using the right delivery modalities at the right times to achieve the best outcomes.

“During our implementation of radiation oncology benefit management services for Humana, we met with the top radiation oncology groups in its network,” Farnsworth said. “These physicians responded positively to our program and acknowledged some of the factors that unnecessarily inflate the cost of radiological cancer treatment. For example, they noted that some of their colleagues treat patients unnecessarily with higher-cost modalities, and others pad revenue by adding treatments.”

In the longer term, ensuring radiation oncology treatment plans conform to evidence-based protocols lowers costs by helping prevent

• recurring cancers, which can result from ineffective radiation delivery;
• secondary cancers caused by unnecessary radiation exposure to healthy tissue; and
• side effects, which can require additional treatment.

HealthHelp manages radiation oncology benefits through its effective and collaborative RadConsult™ program or through RadCert™, which adds precertification to the RadConsult model. In addition, radiation oncology claims are reviewed through the automated CodeRight™ program. Payers have come to depend on these cost-saving programs to manage diagnostic imaging benefits.

HealthHelp provides one-time authorization for complete radiation oncology treatment plans that incorporate 3D conformal radiation, intensity-modulated radiation therapy, stereotactic radiosurgery and radiotherapy, brachytherapy, and proton-beam therapy. Ordering physicians follow the same process and work through the same contact center they currently use to request imaging exams, and they receive evidence-based medical literature supporting best practices in radiation oncology.

HealthHelp’s radiation oncology capabilities can be combined with its effective diagnostic imaging management services, or it can seamlessly complement other, more traditional RBM precertification programs.

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