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Oncology Care Integration

A full-service oncology program to manage risk from detection to transitional care

Oncology Case ManagementOur Oncology Care Integration program provides comprehensive care management from a multi-disciplinary team for members undergoing chemotherapy and radiation for cancer. We begin with understanding the member’s cancer type and stage of disease, as well as any prognosis, cultural and economic needs, and family/caregiver involvement and concerns.

Following a detailed assessment, our multi-disciplinary team works to help improve the member’s health and quality of life, lower rates of complications, reduce gaps in care and control cost. We provide care coordination and side effect management by working collaboratively with the provider to mitigate toxicities, improve treatment compliance and control disease symptoms.

Oncology Care Integration includes the following services:

  • Utilization Management – Medical necessity review for chemotherapy and radiation treatments
  • Case Management – Providing education, support, side-effect management and care coordination to reduce gaps in care
  • Clinical claim audit – Review for volume discrepancies, over prescribing, prescription misuse, and over billing
  • Negotiations – Negotiation support, including provider sign off, for chemotherapy and radiation claims
  • Reporting and outcomes – Plan of treatment reports as well as monthly and quarterly reporting


Product Highlights

  • Cases are managed by ouroncology nurse specialists who are experienced in cancer care
  • Expert support from physician panel, including board certified oncologists
  • Proactive review of all treatment plans using nationally recognized,evidence-based clinical criteria
  • Shared decision making with patients based on their journey goal, stage and prognosis

American Health - Oncology Care Integration.pdf