Evolent program achieves 20% reduction in use of low-value oncology regimens

• Program aims to achieve the best possible treatment outcomes — longer lives with fewer side-effects — without excess financial strain.
• Collegial provider engagement model brings together education, technology and incentives to encourage top-quality regimens.
• One low-value regimen costs about 70 times more than a clinically equivalent alternative.

WASHINGTON, April 15, 2025 /PRNewswire/ -- When treating patients with cancer, oncologists typically can choose from multiple FDA-approved regimens, or combinations of drugs.

While tools such as Evolent's clinical pathways can help them find high-value options, providers have not had similar resources to flag regimens on the opposite side of the spectrum. These other regimens may be associated with lower survival, more severe side effects, or extremely high cost without additional clinical benefits.

Today, in the Journal of Clinical Pathways, Evolent oncology experts reported on their efforts to identify these "low-value regimens" and then decrease their use by more than 20%, following a multifaceted provider education and engagement campaign with a national payer partner.

"For oncologists, selecting between available treatment options can be a close call, but there are certain regimens that miss by a wide margin," said Evolent CMO Emeritus and Senior Advisor Dr. Andrew Hertler. "While low-value options represent a tiny percentage of cancer drugs ordered, avoiding them can have an outsize impact on both the quality and affordability of care for patients. Given that medications are the largest component of spending on cancer care — about 60 percent for Medicare populations — we need to ensure we are investing in therapies that offer patients the greatest promise for longer, better lives."

The low-value regimen program spans therapies across 10 common cancer types, representing about 1 percent of all requests that Evolent receives. Each regimen was identified by Evolent clinical experts after a thorough examination of the medical literature, as well as real-world outcomes. They were then reviewed and approved by the company's Oncology Scientific Advisory Board, which consists of leading community and academic oncologists from across the U.S.

The Evolent team found dramatic differences between high- and low-value regimens. For example, one low-value lung cancer regimen is about 70 times more expensive — or $40,000 more per quarter — than a preferred alternative. Yet the evidence to date does not support that it offers better clinical outcomes.

In early 2023, Evolent and a national health plan partner embarked on a multifaceted campaign to voluntarily reduce use of these regimens in multiple markets. Outreach included provider awareness efforts, such as in-person and virtual forums where Evolent oncology pharmacists reviewed the evidence with practice-based clinicians. White papers and videos also supported the education effort.

Leveraging technology, Evolent also flagged low-value regimens as non-preferred in its clinical decision support system. If a provider still requested one of these therapies, it triggered outreach from an Evolent clinical reviewer, who sought to understand the particulars of the case, go over the evidence, and explore higher-value options the provider could voluntarily switch to.

Evolent also administered pay-for-performance programs that incentivize providers for using preferred regimens while de-incentivizing low-value options. And the use of low-value regimens was a key metric on specialist scorecards that Evolent disseminates to oncology practices and referring providers.

From February through May 2024, the use of low-value regimens decreased by 20.1%, compared to the same four-month period in 2023. That change was driven in large part by shifts in ordering habits — provider requests for low-value regimens dropped by 15.5 percent. 

"The low-value regimen program showcases the power of our provider engagement model to drive change," said Evolent Chief Medical Officer Dr. Von Nguyen. "Increasing providers' awareness of low-value regimens is a critical piece of the puzzle, requiring multiple touchpoints and real relationships built on trust. Still, awareness alone is not enough. We leverage technology, performance reporting and the right incentive structures to keep these issues top of mind and sustain improvement over the long term."

Evolent's low-value regimen program is now active with health plans across the U.S.

About Evolent  
Evolent (NYSE: EVH) specializes in better health outcomes for people with complex conditions through proven solutions that make health care 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 health care nationally. Learn more about how Evolent is changing the way health care is delivered by visiting evolent.com.

Media Contact
Jamie Manfuso
jmanfuso@evolent.com 

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SOURCE Evolent Health, Inc.