Medical Oncology Program
The Medical Oncology Program supports high-quality, high-value medical (pharmaceutical) treatment for adult and pediatric cancers in an outpatient or home setting. The program uses evidence based clinical guidelines to help reduce inappropriate care, overtreatment and excessive costs while promoting optimal drug regimens that have been evaluated for efficacy and safety, including toxicities that can significantly impact quality of life and/or may require hospitalization.
The program offers a prospective review of certain medical oncology drug regimens to promote improved quality of care for all plan beneficiaries by assessing whether the proposed services are medically necessary and, if so, whether the requested regimen is included in AIM Specialty Health’s oncology treatment pathway regimen.
To maximize the benefits achieved by this program, doctors and other health care professionals ordering medical oncology services for their patients must call AIM prior to such services being rendered to allow AIM’s prospective review to occur and for the doctors and other health care professionals to receive the qualitative feedback afforded by these AIM quality improvement programs.
If the planned services do not meet medical necessity criteria and if the regimen is not in AIM’s oncology treatment pathway regimen, AIM may suggest that the doctor or other health care professional consider offering an alternative regimen or withdraw the requested service entirely.