From Specialty Pharmacy News

Horizon Invests in Oncology Firm COTA To Help Docs Offer Patient-Centered Care

SPECIALTY PHARMACY NEWS is designed to help health plans, PBMs, providers and employers contain costs and improve outcomes related to high-cost specialty products.

October 2014Volume 11Issue 10

Horizon Blue Cross and Blue Shield of New Jersey is hoping that its recent investment in COTA, Inc., a technology company focused on oncology management, will help it transform the delivery of health care. The deal, says the Blues plan, will help it to assist physicians in providing patient-centered care that’s focused on value and not volume.

The firm shares its name with its product, a cloud-based data platform that offers real-time clinical outcomes and cost-analysis data for cancer care. More than 100 practicing oncologists and national leaders in cancer biostatistics and reimbursement contributed data to it. The offering is able to sort patients according to very specific subsets of information and provide outcomes tracking in areas such as overall survival, progression-free survival and costs. When providers enter detailed information on their patients, they are able to see how that experience compares with other similar ones, which in turn allows them to make better treatment decisions by narrowing down the most effective approaches.

COTA — which stands for “Cancer Outcomes Tracking and Analysis” — “provides oncologists a number of actionable clinical and financial reports for the patients they are caring for,” explains Kelly Choi, M.D., the firm’s chief operating officer. “The key is that COTA can parse down to the finest of patient subtypes within a particular type of cancer. As an example, for a particular subtype of breast cancer, an oncologist who is running a practice of multiple oncologists can see if all of their oncologists are consistently using NCCN [i.e., National Comprehensive Cancer Network]-approved regimens as well as see his/her operational efficiency and margins for the services provided for that particular subtype of breast cancer patient. The specific actions of course are unique to the practice depending on what the data shows.”

Horizon Supports Data Platform

The company was founded in 2011 by hematologist/oncologist Andrew Pecora, M.D., who also serves as executive chairman. Pecora, who is vice president, cancer services, and chief innovation officer for the John Theurer Cancer Center in Hackensack, N.J., formed the company “when he saw the major gap in data tracking and analysis, particularly within oncology,” says Choi.

In late September, COTA closed $3.7 million in a planned $7 million Series A funding round in which Horizon “was the lead investor,” Choi tells SPN. “While we have been active in the oncology space working with oncologists as well as other customers and partners, our recent Series A funding will allow us to further expand the COTA platform.” Prior to that, private sources and Regional Cancer Care Associates, a group with more than 100 oncologists, provided COTA with a seed round of funding.

Thomas Vincz, spokesperson for Horizon, tells SPN that his health plan “made a significant investment in COTA’s business. Horizon is leading the effort to change the delivery of health care in New Jersey through patient-centered based practices that are focused on quality versus quantity of care.” Horizon now has more than 500,000 of its 3.7 million members in patient-centered programs, with more than 3,700 participating physicians at 900 practice locations.

“This investment is a way that Horizon can assist companies with the development of software, data analytics and information services to further this effort,” maintains Vincz.

Glenn Pomerantz, M.D., vice president and chief medical officer of Horizon, will serve on COTA’s board of directors, as will a second Horizon person who will be named later.

Data Will Help Transition to Value-Based Care

Amidst growing concerns over skyrocketing health care costs that may not provide comparable returns on investment, more stakeholders within the industry are implementing value-based care models. COTA, contends the company, will help oncologists transition from fee-for-service care to these value-based approaches.

“COTA’s technology provides clinical data and information services to enable real-time care management and comparison of quality outcomes between patients with specific types of cancer,” says Vincz. “This technology will help improve the tracking of outcome data, quality and care coordination, and standardization of the highest quality care for patients with oncologic conditions. This will allow for very specific quality and outcomes metrics to be tracked, which will support bundled payment arrangements, which are focused on reimbursement for improved quality.”

“In the new value-based reimbursement world, oncologists will need to understand the population of patients they are managing to a very specific level in order to track progress, change treatment plans as needed, and understand and manage their costs at a much more granular level,” Choi tells SPN. “COTA empowers users with the ability to sort cancer patients to the highest degree of specificity. Oncologists can thus glean a level of actionable and insightful analysis that no other system today can do.”

Choi explains that COTA “is purely an outcomes and cost-tracking database. We do not publish guidelines nor make any clinical recommendations like the NCCN. We are completely compatible with guidelines and pathways since we do not tell an oncologist what to do — we merely show him/her the consequences of their actions.”

Pricing for use of the platform “remains confidential at the moment,” says Choi. “We charge the oncologists a nominal fee to use COTA, mainly to cover operating costs. We do not want to be a financial burden for the oncologists. We believe the payers have the most to gain from improved quality and lowering unnecessary costs, and we are pricing for health plans accordingly.” She tells SPN that COTA has “several pending” contracts with health plans. “We can’t share any specific details at the moment, but [they] will be made public in the coming weeks,” she adds.

COTA also is looking to broaden its data. At this point, “New Jersey is the primary geographical area represented in our data, but we do have a few pilots in the Southeast and a soon-to-be pilot in the West,” Choi says. “We absolutely expect there will be differences given we are seeing some big variance even in the state of New Jersey. However, we are waiting for a bit more data before we make any specific statements.”

According to Choi, “We are focused right now on scaling our company. Our goal is for COTA at a national level to enable higher quality care while reducing unnecessary expenditures so that patients now and in future generations will get the care they need.”

© 2014 by Atlantic Information Services, Inc. All Rights Reserved.

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