New oncology model from Humana, Evolent and American Oncology Network eliminates prior authorization burden

LOUISVILLE, Ky.--(BUSINESS WIRE)-- Humana Inc., in collaboration with Evolent Health, Inc. and American Oncology Network (AON), today announced the launch of a new cancer care model designed to improve the quality, timeliness and affordability of cancer care while reducing reliance on traditional prior authorization.

The model has initially been rolled out across eight states to clinics within AON, one of the nation’s fastest-growing community oncology networks.

“We are committed to easing access to quality oncology care for our members and helping to reduce the administrative burden for providers,” said Dr. Traci Granston, Humana Vice President of Clinical Innovation. “A cancer diagnosis is difficult news to hear. By making access to affordable, quality care even easier to navigate and enabling more efficient use of high-cost therapies, we are working to ease the burden of cancer treatment. When members can accelerate the start of cancer treatment, the probability of better health outcomes increases.”

In this model, participating AON providers have a streamlined process for managing most anticancer drug therapies. Practices that demonstrate adherence to established quality and evidence-based treatment standards will no longer need to submit traditional prior authorization requests for those therapies. AON practices are also participating in quality improvement initiatives targeting high-impact opportunities to make care more effective and affordable. As an example, periodic testing of patients receiving immunotherapy can determine whether they are still responding to treatment or if other approaches should be considered. Automated reminders in the AON electronic health record (EHR), in combination with provider education and performance scorecards, aim to increase adoption of these high-value steps. Evolent supports the model through its oncology clinical pathways, quality improvement programs and provider performance reporting.

“We are excited to support Humana members living with cancer through this model,” said Dr. Stephen "Fred" Divers, AON Chief Medical Officer. “Community oncology centers are the lifeblood of the cancer treatment landscape. Through this partnership, we’re bringing them the latest evidence and proven quality interventions to support their treatment decisions, while avoiding the typical friction around approvals that frustrates patients and providers.”

Providers also benefit from a data-driven analytics platform that leverages real-time EHR data to deliver clinical insights and guide the creation of personalized cancer treatment plans. The platform, powered by Meaningful Insights Biotech Analytics (MiBA) and developed in collaboration with AON, applies analytics and algorithms to uncover patterns, trends and correlations that can improve patient care and drive innovation.

“Clinical innovation is not simply about introducing new technology. It is about creating systems and partnerships that make it easier for our care teams to do what is right for patients,” said AON Vice President of Clinical Innovation Susan Sabo-Wagner. "This collaboration represents an opportunity to shift from retrospective approvals toward proactive clinical quality improvement, where physicians and health plans work from trusted clinical information to support timely, appropriate care.”

This new agreement builds on a relationship of more than 20 years between Humana and Evolent, including through Evolent’s New Century Health business, to improve outcomes for members with complex health conditions.

“We’re honored by the trust that Humana has placed in us over the years to support its members in some of their most pivotal health moments,” said Evolent Chief Medical Officer Dr. Von Nguyen. “This new oncology model is emblematic of a partnership that is energized by the opportunity to rethink healthcare and innovate. Together with AON, we’re building a model that reduces reliance on prior authorization by aligning payers and providers around quality and affordability.”

About Humana

Humana (NYSE:HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell® healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

About Evolent

Evolent (NYSE: EVH) specializes in better health outcomes for people with complex conditions through proven solutions that make healthcare simpler and more affordable. Evolent serves a national base of leading payers and providers and is consistently recognized as a top place to work in healthcare nationally. Learn more about how Evolent is changing the way healthcare is delivered by visiting evolent.com.

About American Oncology Network

American Oncology Network (AON) is an alliance of physicians and seasoned healthcare leaders partnering to ensure the long-term success and viability of community oncology and other specialties. Founded in 2018, AON’s rapidly expanding network represents more than 350 providers practicing across 21 states. AON pioneers innovative healthcare solutions through its physician-led model, fostering value-based care that improves patient outcomes while reducing costs and expanding access to quality care. AON equips its network physicians with the tools they need to thrive independently while providing comprehensive support, integrated revenue-diversifying ancillary services, and practice management expertise, enabling physicians to focus on what matters most – providing the highest standard of care for every patient. AON is committed to promoting health equity by addressing disparities in cancer care and ensuring that all patients have access to the care they need to achieve optimal health outcomes. With a focus on innovation and collaboration, AON is shaping the future of community oncology. For more information, please visit AONcology.com or follow us on LinkedIn, Facebook, X (formerly Twitter) and YouTube.