How UnitedHealthcare Incorporates Real-World Evidence Into Cancer Care Decision-Making, Policy Formulation

Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare, talks about how UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs.

Transcript

With real-world evidence becoming increasingly important in decision-making related to cancer drug and testing reimbursement, how is UnitedHealthcare integrating it into its reimbursement policies?

Real-world evidence is becoming increasingly important, as you said, and we use it in our pathways design. When we have 2 regimens that are equivalent, as I mentioned before, we use the real-world evidence that we have with United members to look at how each regimen impacts utilization of health resources and cost, of course.

In our policies, we also use real-world evidence. So, when we write policies or we review policies or renew them, we're looking very carefully at how the policy is impacting the member population, what the utilization rates are, and how those policies play out in the real-world evidence. I think there's a lot of room to go with real-world evidence, and in particular, when we're thinking about molecular testing, for example, I think we can really leverage more of that to help determine the best test for the right patient at the right time.

What specific challenges or opportunities have you encountered when incorporating real-world evidence into your decision-making processes?

I think that the real-world evidence limitations are similar to limitations from clinical trials, but on a bigger scale. So, with clinical trial data you always wonder, does that trial apply directly to my patient? And with real-world evidence, it's a question of, are we defining the populations correctly, and are we getting the right patients or the right members in that evidence block to really inform the question that we're trying to answer?

I think we are limited in any particular institution where we're doing real-world evidence with our own data, is that it's only our own data. So, from a payer perspective, when you're looking at real-world evidence, you're looking at members that might go in and out of coverage, they might go from one payer to another or one employer to another, their information may be lost along the way. So we are always looking at a somewhat incomplete picture.