On Nov. 1, 2019, UnitedHealthcare introduced the new Cancer Therapy Pathways Program to promote the use of evidence-based and cost-effective regimens. Beginning Jan. 1, 2020, care providers also will be able to receive rewards based on pathway adherence. Rewards will only be available for select UnitedHealthcare commercial plans (excludes Oxford Health Plans).
Cancer Therapy Pathways will be available for most common cancer types and include options for defined biomarker subsets and lines of therapy. However, given the complexity of cancer, we don’t expect to have a pathway for every medical condition.
Cancer Therapy Pathways is not a substitute for the experience and judgment of a physician or other health care professional. Any clinician participating in the program must use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. Care decisions are between the care provider and the patient. We don’t make decisions about the kind of care that should be received.
Cancer Therapy Pathways are available through Optum’s Cancer Guidance Program, which is accessed through Link when submitting an authorization request for any UnitedHealthcare commercial plan (excluding UnitedHealthcare Oxford commercial plans), UnitedHealthcare Community Plan and UnitedHealthcare Medicare Advantage Plan members. Selection of a pathway regimen is not required to receive prior authorization for therapy. UnitedHealthcare’s criteria for coverage determinations for cancer therapies will not change as a result of this program.
Care providers will have the opportunity to receive rewards through a financial incentive based on pathway adherence. To be eligible for a reward, pathway adherence must be 75% or greater at the practice level during the performance measurement period, which is a six month period of time. Additional criteria and exclusions may apply. Rewards will be assessed and distributed bi-annually. Detailed information on rewards is forthcoming and will be available on UHCprovider.com in mid-December.