US Oncology is the premier cancer care services company in the United States working with physicians, biopharmaceutical companies, medical equipment manufacturers and payers to identify and deliver innovative services that improve patient access to advanced, integrated cancer care in the community setting. The company is affiliated with 1,211 physicians operating in 456 locations, including 94 radiation oncology facilities in 39 states.  In January of 2007, US Oncology partnered with Deloitte Consulting to develop an innovative patient centric case management software to service the US Oncology cancer patients which accounts for 15% of all cancer patients in America.
  
The system supports multiple US Oncology business lines that service the patients:

AccessMED guides physicians, patients, hospitals, pharmacists, pharmaceutical companies, and device manufacturers through the jungle of government regulations and payer policies to clear reimbursement pathways for the most challenging and innovative products. The reimbursement support programs provided through AccessMED connect patients with funding resources that give them access to life-saving treatments.  AccessMED brings proven success in verifying insurance, resolving complex denied claims, and identifying funding resources for seemingly uninsured or underinsured patients.  AccessMED enhances the typical patient assistance screening and qualification process by connecting patients with available drug coverage.

Innovent Oncology is an integrated program that facilitates collaboration between physicians and payers to address the complexity and costs of quality cancer care.  Part of this program focuses on Patient Support Services otherwise referenced as Disease Management.  This service is initiated by nurses at the oncology practice and focuses on the patient well-being between visits to the oncologist.  Disease Management provides on-going patient education throughout the entire course of treatment.  This service helps patients who are having difficulty comprehending the disease and the designation of having cancer.  The CARxES call center answers questions and informs patients of expected side effects based on their specific treatment.  Information is also distributed to care givers of the cancer patients so they also know what to expect and understand when the patients condition is concerning versus an expected side effect.

OncologyRx Care Advantage is a national oral oncology pharmacy developed by US Oncology that brings clinical oncology expertise to the delivery and management of oral therapies associated with cancer care.  This innovative specialty pharmacy was designed with oncologists input to optimize patient care and to optimize patient outcomes, adherence and compliance.  Care Advantage handles the increased responsibilities that come with the growing numbers of oral cancer therapeutics.  They manage the complex financials coordination these drugs require, and take care of the patient follow-up to guide therapy adherence all toward achieving optimum outcomes for patients.  Care Advantage means increased patient adherence, improved patient outcomes, greater patient satisfaction, and up-to-date patient information for health care providers.    

Oncology Reimbursement Solutions (ORS) offers independent oncology practices comprehensive bill and revenue cycle management, customized for the complexity of cancer care. The solution expands beyond the services provided by most third-party billing companies to provide practice staff with tools and training to improve those functions, which in turn support the back-office functions managed by the experienced ORS staff.  The result is increased operational efficiency that significantly improves practice financial performance, allowing practices to focus on providing cancer patients with the advanced clinical care they need.

Technology played a key role in the companys ability to provide an economic solution using a common platform that would support all services: AccessMED, Innovent Oncology, OncologyRx Care Advantage and Oncology Reimbursement Solutions. With the help of Deloitte Consulting, US Oncology turned the Siebel CRM application into a patient-centric case management system that saved money and served all the businesses.
 
Requirements for all services were gathered, reconciled and aligned into a common core. Unique requirements for specific services were built as extensions to the core application. This allowed the different businesses to leverage each others capabilities and provide a higher quality, more cost effective patient care model.

Shared capability requirements:
	Patient management: Enrolling a patient into the relevant program, capturing various information including demographics, policy data, patient contacts, cancer treatment contact, etc
	Case management: Defining and managing multiple cases for a given patient, including reimbursement requests and disease management cases
	Activity management: Enabling predefined activity plans/templates and ad-hoc activities to track past and future activities related to a patient case
	Document generation: Using patient or case data to automatically generate postal letters or other printed documents to patients, providers or other parties
	Shared data entities: Sharing data definitions for non-transactional entities like facilities, providers, payers, diagnosis codes, etc
	Content Management: Storing and controlling access to relevant documentation to support the various business functions
	HIPAA Compliance: Ensuring that end-users only have access to the data they need to complete their job function, as well as tracking all user access to sensitive patient data 

Requirements specific to reimbursement services:
	Eligibility Rules: Configurable rules to determine a patients eligibility for free or discounted drugs for each of the pharmaceuticals covered by the program
	Order Capture: Ability to capture orders for free/discounted drugs
	Patient Portal: A patient-facing portal allowing patients to view and redeem awarded coupons for discounted drugs

Requirements specific to disease management and medication therapy management services:
	Education scripts: Configurable call scripts for call center nurses to provide education on specific topics related to cancers, treatment options, side effects and related advice

Solution Delivered Tailor-fitted best practices
The delivered solution was based on the Siebel 7.8 Financial Services base application, under which health care data subjects fall. Additional modules included providers and facilities, contracts, coverages, quote and order capture, reports (Actuate), smart scripts and the eCustomer portal.

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For AccessMED, the new Siebel case management system presented an opportunity to create a web-based, self-service customer portal to supplement the traditional US Oncology call center services, such as the patient brand loyalty program.  As part of the larger Siebel project, AccessMED developed a patient-centric web portal which allows patients to enroll in the program and manage their accounts on-line. 

This same technology is being leveraged to develop healthcare professional (HCP) web portals for some of AccessMED's other biopharmaceutical customers.  The benefit of these portals is that it allows HCPs (i.e. financial counselors, practice administrators, nurses, providers) to access AccessMED's reimbursement support hotlines and patient assistance programs when it is convenient for them instead of being restricted to the call center's hours of operation.  Many physician practices do not have time during a standard work day to contact AccessMED's call center so the web portal provides them with a 24/7/365 self-service channel into the support services.  HCPs have the ability to submit patient assistance program applications via the web portal which dramatically reduces the number of incomplete applications received by the programs.  This is important because incomplete applications can increase by up to 8+ business days the amount of time it takes to get the Patient Assistance Programs (PAP) product to the provider or patient.  

With Innovent Oncology, the Siebel CRM platform has enabled the Patient Support Services oncology nurses to have meaningful and timely interactions with patients undergoing treatment for cancer as well as for those facing end of life and to effectively track and report interactions for both internal and external customers.

Through the scheduling function, nurses can reach out to patients at key points during their treatment to evaluate patient understanding of their disease, side effects and disease management. Based on these assessments, nurses can empower patients to manage their care between doctor visits and to understand when to seek medical treatment, reducing avoidable trips to the emergency room and improving the patients quality of life.

Seibel CRM also offers the flexibility to develop and maintain essential patient-focused, evidence-based education scripting and materials to support nursing intervention, and supports high quality storage of selected cancer education materials for efficient information disbursement to the patients.  

Due to the real time nature of the data, regular review, inaccuracies of entry or user training issues are identified quickly and corrected within a timely period. Siebel data supports the capture and tracking of key Innovent performance outcomes, providing direction for future operational and clinical process improvements.

In the past, OncologyRx Care Advantage depended on a series of linked worksheets and database oriented applications to manage incoming prescription referrals, track work-flow and provide process validation. Today, Siebel CRM has allowed for the consolidation of these multiple tracking and software tools into one concise application.  Not only has Care Advantage seen improved referral and prescription processing times and staff efficiencies, it now has the ability to accurately report and analyze for on-going operational and customer service improvement opportunities through the implementation of Siebel CRM.

As the implementation process continues to evolve and mature, Care Advantage will look to Siebel CRM to support its clinical team of nurses and pharmacists as part of its CARxES program in scheduling follow-up calls and recording the outcomes associated with these critical interventions. The system will also provide new capabilities in understanding a patients drug insurance benefit structure and financial situation leading to the ability to acquire financial assistance where needed in a much timelier fashion.

Even though financial benefits are definitely sought when endorsing a project, the company truly looks for ways to improve the experience for the cancer patient.  This project not only has aspects that benefited the patient during their treatment of cancer, but also provided financial benefits.

In 2008, the US Oncology Patient Assistance Support program proved to be an extreme value to US Oncology patients and its network of affiliated practices by reporting substantial growth and a high rate of successful outcomes. The number of cases submitted to the Patient Assistance Support program increased by 41.5% over 2007. The case growth resulted in a net revenue increase of 57%. The mission of the US Oncology Patient Assistance Support group is to remove financial barriers faced by patients impacting their cancer care by obtaining co-pay/co-insurance, accessing programs which pharmaceutical companies provides free cancer drugs for qualifying patients and appealing claim denials resulting in payer policy changes. The net impact of this teams mission to US Oncology cancer patients exceeded $11 million dollars in 2008.

By taking an existing robust system with flexibility and scalability, and combining the needs of multiple businesses into a single platform, US Oncology was able to create a cost-effective and efficient solution that collects, manages and analyzes data to better serve cancer patients now and in the future.

Each solution component had its own distinct value driver:
	Common Patient Management Functionality and Data for consistent patient service: Used the module with contracts and coverages to enable enrollment of patients and track their relationships to payers, facilities, providers, diseases and treatments. The maintenance of this core patient information was designed to be reused across the business functions as well as future initiatives, thus helping to reduce the multitude of disparate and isolated descriptions of a given patient.
	Robust Case Management to ensure quality and effectiveness of patient services: Based on Siebels Service Request functionality, cases represented the back-bone of the solution for all the divisions. It represented the active management of reimbursement requests for Disease Management and Medication Therapy Management services. A patient could have multiple cases, and as such, allowed a clear separation of case-specific data and shareable patient data.
	Integrated Order Capture to expedite the patients access to required medication: Using Siebel's quote and order capture module, reimbursement agents could capture orders for drugs that were exported to the relevant pharmacy as soon as eligibility was established and documented.  This shortens the time it takes to get the pharmaceuticals in the hands of the patients.
	Reimbursement Eligibility Scripts to ensure consistent and efficient evaluation of a patients eligibility for free or discounted drugs: Based on Siebel Smart Scripts, this engine determined if patients were eligible for free or subsidized drugs. The ability to match uninsured or underinsured patients to free or discounted pharmaceuticals is a huge financial benefit to the patient.
	Navigational Education Scripts to help nurses provide the relevant education for the topic at hand: Also based on Siebel Smart Scripts, this large script engine provided Disease Management nurses all the content required to properly educate patients on topics related to their disease and treatments. It was customized to be more data driven rather than the out-of-box solution, allowing for very complex navigation trees to be easily administered. The navigational trees were dynamic to take past navigations into account: E.g. a list of educational topics around side effects would be filtered by relevant side effects for the drug being discussed. It was further enhanced to track which education was provided to the patient as well as flag particularly interesting topics to be printed and mailed to the patient after the call.  
	Automated Document Generation for efficient communication with patients, providers, payers and other parties: This module helped automatically generate correspondence related to a case. 
	Patient Portal to allow patient self-service: Based on Siebel's eCustomer module, a patient-facing portal and user interface was configured to allow patients to enroll on-line to apply for subsidized drugs and redeem awarded certificates for discounts on drugs. The web templates and style sheets were customized to make the Siebel portal look identical to the legacy, home-grown portal. The technology switch was transparent to the patients.
	HIPAA Security Standards and Audit Logs to protect patients and ensure legal compliance: Siebel has very powerful authorization mechanisms which were essential to provide the right users access to the correct data.  A customized logging engine was built that a specific patient could be flagged for extra monitoring (showing everyone who can view a particular patient record) or a specific employee could likewise be flagged (showing all patients a particular employee has viewed).

We had to collect and collaborate the needs of very different business units who had very different business priorities into one platform that could serve all. The business units were each at a different level of technology needs as well; ie: AccessMed was a well-established company with an already robust technology system. They knew what they wanted and they needed it quickly. On the other hand, Innovent Oncology was a brand new business and was still determining their needs as the system was being built. 

Creating a system that catered to all businesses through one application required a lot of thought and collaboration. Whenever one business had a need change, we had to double back and compare how that change would affect the application for the other users. 

Resources also proved to be a challenge. Budgets were tight, demands were high, and deadlines came quickly. There was no team in place to support this system once US Oncology took over the implementation from Deloitte, so we had to build a team from scratch. Specific skills were necessary, which made recruiting a challenge. We recruited  experts from around the country and convinced them to relocate to Houston, Texas.

Some of the business units already had custom-built applications and they had no desire to implement a new system. Others wanted or needed a new system, but were not completely sold on the Siebel solution. US Oncology needed to get these businesses working collaboratively on one system so that data could be more easily collected, managed and analyzed to help advance technologies and care for the patients. Ultimately, we got everyone working on a common system with branches that serve each business units specific needs, and we can now better manage the data. Now that the system is implemented, the business units are working well together, but there was a tremendous amount of resistence in the initial phases and through implementation.

Achieved

Information gathering through a common platform from multiple businesses can more readily and easily collect, manage and analyze data. The protection applications built-into this program can easily cross over into protection processes for other businesses and organizations. As the needs of cancer patients and cancer care grow, so too will this platform. 

Globally, the information gathered, managed and analyzed through this system can be used by researchers, manufacturers, providers, payers, legislators and others concerned with quality cancer care to enhance patient access, adherence, and the overall care necessary to eradicate cancer as a major health problem in America.

Some of the businesses quickly embraced the new technology and others have been slower in its adoption, but all have been satisfied with its application. 

AccessMed embraced the new technology and uses the application extensively. There are currently approximately 60 AccessMed users. Innovent Oncology currently has approximately 10 users. This is a new business which is still defining its needs. This business was launched in September 2008, but is currently ramping up quickly with plans for major expansions in 2009. 

Oncology Reimbursement Solutions and OncologyRx Care Advantage were slower to adopt the technology, but are now realizing its true value. OncologyRx Care Advantage has the biggest expansion plans for the system in 2009 to integrate Siebel with the current pharmacy application Rx3000 and with the US Oncology EMR system, iKnowMed. 

The system also hosts two external portals to pharmaceutical companies.  Eli Lilly will participate in the systems provider portal, which is scheduled to launch in March 2009. They are expected to have 100 to 200 immediate users, with continued growth through the years. CSL Behring participates in the patient portal with 400 current registered users. This group is the most technology savvy users; they knew what they wanted, which made it easy to cater to their needs and they found the program easy to adapt.