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

Rhea-AI Summary

Evolent Health has reported significant success in reducing the use of low-value oncology treatment regimens by over 20% through their provider education and engagement campaign. The program, detailed in the Journal of Clinical Pathways, focuses on identifying and decreasing the use of treatments that may have lower survival rates, more severe side effects, or excessive costs without additional clinical benefits.

The initiative spans therapies across 10 common cancer types, representing about 1% of all requests. In one striking example, a low-value lung cancer regimen was found to be approximately 70 times more expensive ($40,000 more per quarter) than a preferred alternative, without supporting evidence for better clinical outcomes.

From February through May 2024, the program achieved a 20.1% reduction in low-value regimen usage compared to the same period in 2023, with provider requests for such regimens dropping by 15.5%. The success was attributed to a comprehensive approach combining provider education, technology-enabled clinical decision support, and performance incentives.

Positive

• Achieved 20.1% reduction in use of low-value oncology regimens
• Provider requests for low-value treatments decreased by 15.5%
• Potential cost savings of up to $40,000 per quarter per patient in some cases
• Successfully implemented across multiple U.S. health plans

Negative

• 1% of current treatment requests still comprise low-value regimens
• Some cancer treatments cost 70x more than alternatives without proven better outcomes

Insights

Healthcare Financial Analyst

Evolent Health's oncology program represents a significant value proposition in the healthcare cost management space. The 20.1% reduction in low-value regimen usage demonstrates measurable results that should appeal to health plans – Evolent's primary customers. Most notably, the article highlights a case where one low-value lung cancer treatment costs $40,000 more per quarter (70 times more expensive) than a clinically equivalent alternative, presenting a compelling ROI argument.

This program directly addresses the largest component of cancer care spending – medications account for approximately 60% of Medicare oncology costs. By focusing on the 1% of regimens identified as low-value, Evolent has created a targeted intervention with outsized financial impact.

What's particularly valuable is Evolent's multi-faceted implementation approach: combining provider education, technology-enabled decision support, and aligned financial incentives. The 15.5% decrease in provider requests for low-value regimens suggests genuine physician behavior change, which is notoriously difficult to achieve in healthcare.

The nationwide expansion of this program to multiple health plans indicates strong market reception and likely recurring revenue opportunities as these implementations scale. This initiative strengthens Evolent's position as a value-based care enabler at a time when payers are increasingly focused on specialty care cost management.

Oncology Clinical Director

Evolent's approach to identifying and reducing low-value oncology regimens represents a sophisticated clinical intervention. The program targets treatments that may deliver suboptimal survival, increased toxicity, or unjustifiable costs – addressing the complete spectrum of the value equation in cancer care.

The methodology appears robust, with regimen classification based on both literature evidence and real-world outcomes data. The validation through Evolent's Scientific Advisory Board, which includes both community and academic oncologists, adds considerable credibility to their classifications.

What's most impressive is how they've overcome the traditional resistance to standardization in oncology. Rather than imposing blunt restrictions, their collegial engagement model preserves physician autonomy while creating multiple touchpoints to influence decision-making. The combination of education, clinical decision support flags, and direct specialist-to-specialist discussions represents best practices in changing entrenched prescribing patterns.

The 20.1% reduction achieved is clinically meaningful. With cancer drugs accounting for 60% of Medicare oncology spending, even small shifts away from unnecessarily expensive regimens can free substantial resources for other aspects of patient care. The emphasis on maintaining or improving clinical outcomes while reducing costs aligns perfectly with value-based care principles that increasingly drive reimbursement models.

• 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.

FAQ

What percentage reduction did Evolent Health (EVH) achieve in low-value oncology regimens?

Evolent achieved a 20.1% reduction in low-value oncology regimen usage from February through May 2024 compared to the same period in 2023.

How much more expensive is the low-value lung cancer regimen compared to the preferred alternative?

The low-value lung cancer regimen is 70 times more expensive, costing $40,000 more per quarter than the preferred alternative.

What percentage of Evolent's total oncology requests are considered low-value regimens?

Low-value regimens represent approximately 1% of all requests that Evolent receives.

How did Evolent's provider engagement program impact request patterns for low-value regimens?

Provider requests for low-value regimens decreased by 15.5% following the implementation of Evolent's education and engagement program.

What percentage of cancer care spending is attributed to medications in Medicare populations?

Medications account for approximately 60% of spending on cancer care for Medicare populations.