PATHWAYS
Commercial Payers
This Commercial Payer pathway covers various topics that begin with an Intro to Managed Care Organizations. Clinical Pathways, Clinical Guidelines, Specialty Pharmacy, White Bagging and Brown Bagging are covered as well as Payer and PBM Policies Used to Contain Costs, Follow the Vial and Follow the Pill.
Modulettes
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Outlines how clinical pathways are developed and used in oncology care decision making
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Outlines how clinical guidelines are developed and guide in oncology care decision making
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Explanation of how insurers use these strategies to shift the cost of drugs to manufacturers and patients
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Provides an overview of episode-based payment models piloted in oncology care
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Follows an outpatient specialty drug used in cancer from drug manufacturer to patient
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Follows a physician-administered drug used in cancer through the pharmaceutical supply chain
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Provides key information on the formation of IDNs
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Explains the basics of MCOs and roles of key decision makers
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Expalins CMS-approved compendia and off-label use
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Details the value-based Oncology Medical Home (OMH) payment model
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Defines and discusses the specialty drug marketplace
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Outlines the shift to value-based care, explores care frameworks and reimbursement strategies that consider patients' outcomes
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Explains the various incentive-based payment programs that are moving providers and healthcare teams from fee-for-service to value-based healthcare
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Defines the various terms used in physician-administered drug reimbursement
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Defines the terms and what they mean in the distribution process of drugs used in cancer care