272 Background: New Century Health is an Oncology Care Management company. Evidence-based medicine is not a new trend, however, we believe that New Century Health has developed a way to quantify quality and cost outcomes based on our innovative approach to utilizing Clinical Pathways and Compendia. Methods: A retrospective clinical review was performed on 1,938 chemotherapy treatment requests (CTRs) withdrawn or recommended adverse determination (RAD), in calendar year 2012, for two national health insurance carriers. Financial impact associated with the clinical intervention was calculated at ASP +6%, net of confirmed resubmissions. Resubmissions are defined as those approved treatment requests received within one month of the original withdrawal/RAD for an alternative treatment resulting from the original withdrawal/RAD. Financial impact of gross administrative errors was mitigated through manual adjustments to the projected costs. Results: The average combined membership was 795,679; 5,731 unique patients had requests for chemotherapy treatment during 2012, generating 15,446 CTRs. Twelve point five (12.5) percent (1,938) of those were withdrawn/RAD resulting in a net impact of $15.1 million. Of the 1,938 withdrawn/RAD, 12.4% (241) resulted in increased quality with an associated increase in cost ($1.8M). Conclusions: New Century Health believes that cost effective treatment is a function of quality and not the ultimate goal at the expense of patient outcomes. Detailed retrospective case studies were performed on all of the requests that resulted in additional costs. New Century Health believes that in each case the quality of care or patient safety was significantly improved by our peer-to-peer clinical interventions. This is a patient-centric innovative approach to evidence-based medicine that embraces necessary cost increases in favor of clinical quality and patient safety.
Can evidence-based medicine and clinical quality improvement learn from each other?