AArete Helps Medicaid MCO Reduce Suboptimal Radiation Therapy
Situation
A bioinformatics firm presented a national Managed Care Organization (MCO) with opportunities to reduce spend on complications from suboptimal Radiation Therapy (RT). The external firm was unable to validate the findings, so the MCO engaged AArete to review the data and help develop implementation strategies. Other goals included identifying methods to reduce variability in RT treatment and positioning the MCO to be an innovator in oncology management.
Approach
AArete’s analytics and consulting teams, in collaboration with clinical executives, reviewed medical histories to identify instances in which patients experienced complications from RT. We identified the scope by removing direct and indirect RT spend, in addition to spend on services that had a low likelihood of resulting from suboptimal therapy. AArete identified trends in demographic and geographic cohorts to develop a customized improvement strategy.
Results
Our implementation plan focused on enhancing clinical behavior to ensure optimal RT and reduce long-term complications. We developed a stepped approach, which allowed providers to enhance skills over time while simultaneously introducing more stringent compliance requirements, ultimately presenting savings of up to 53% of the scope.
