Medical Oncology Solution
Evidence-guided oncology solution for better cancer care
Our Medical Oncology Solution helps health plans improve cancer care through evidence-based medical benefits management. This approach combines cancer treatment pathways, provider-preferred clinical review, and reimbursement reporting to support clinically appropriate care, provider alignment, and clearer value. Covering 85% of spending on cancer drugs1, our solution manages therapeutic and supportive drugs.
Lines of business
- Commercial
- Medicare
- Medicaid
- Federal employee
How oncology benefit management improves cancer care
Cancer care requires health plans to balance clinical complexity, provider needs, member experience, and rapidly rising costs. Carelon brings these priorities together, providing health plans a strong foundation for supporting cancer care. This includes a focus on safety and appropriateness, rapid, provider-friendly decision support, and clear value metrics.
Optimize your members’ cancer care
Cancer treatment can create physical, emotional, and financial concerns for your members. We support clinically appropriate care through evidence-based oncology pathways aligned with specialty medical society guidelines, helping promote consistent treatment decisions while keeping members at the center of care.
Build closer relationships with oncology providers
Improving cancer care for your members requires deep partnerships with providers. We help build them. We support oncology practices with education, dedicated engagement, and ongoing guidance to help them navigate treatment pathways and clinical review with greater clarity and confidence.
Ease your cost management and shift to value
Oncology care can represent a significant cost for health plans. But it’s not always clear where that spending is going. We bring greater visibility into utilization and spending while creating opportunities for savings. This helps you better manage increasing costs and advance value-based specialty care.
What’s included in our Medical Oncology Solution
Our oncology benefit management solution is designed to help health plans, providers, and care teams work together more effectively. Our solution’s features foster collaboration among your providers, your business, and others that can make an impact on whole health, like palliative care teams.
Clinical appropriateness review
Optimized cancer treatment pathways
Management of biosimilars and other preferred drugs (optional)
Clinical setting optimization
Dedicated practice-engagement team
Advanced analytics for you and your providers
Cancer Care Engagement
How oncology benefits management and utilization review work
Request
Your providers submit requests to us online or by phone.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Determine
Requests that meet clinical criteria can be approved immediately. When additional review is needed, our clinical reviewers, including board-certified medical oncologists and nurses, are available to consult with your providers about requests that don’t meet our clinical criteria or the health plan’s medical policy.
Synchronize
We share request data with your system(s) for claims, care management, or reporting purposes, as applicable.
Ask us about our Medical Oncology Solution
Connect with us to explore the potential impact of our Medical Oncology Solution for your health plan.
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Frequently asked questions about medical oncology solutions
Are you a health plan member?
If you’re a health plan member and have a question about your health plan, please call the Member Services number on the back of your member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 800-252-2021 or contact our support team .
Business hours: 8 a.m. to 5 p.m. CT.