“Robin’s” ITA nurse saw a problem the moment she opened the files.  The metastatic breast cancer patient was receiving the new oral chemotherapy, Tykerb, but not its FDA-approved counterpart, Xeloda.  A call to her doctor revealed a limited prescription policy made Xeloda too expensive for Robin. Her insurer did cover weekly chemotherapy infusions, although they’re unproven with Tykerb. ITA called the insurer.  The infusions weren’t standard of care, and four months of them had cost $54,400.  The best care — Xeloda — would have cost $16,800.  ITA and a health plan case manager soon found a solution: an antiquated hospital billing system had hidden the fact that Robin had met her deductible.  Claims were updated, and Robin was switched to Xeloda without a co-pay. Total cost savings to date exceed $117,000.

“Mary” faced six, 4-day hospitalizations for infusional chemotherapy for stage 4 leimyosarcoma.  Mary desperately wanted the outpatient care her health plan had denied, and her husband was threatening to sue.  ITA’s Chief Medical Officer did an urgent treatment plan review, talked with the attending medical oncologist, and affirmed that outpatient chemotherapy matched the latest treatment guidelines for this case.  Her insurer reversed its decision, and Mary’s treatment occurred as prescribed.  The insurer saved $42,400 by avoiding lengthy hospital stays.

“Robert,” 51, had limited-stage, small cell lung cancer.  He was prescribed a potent mix of chemotherapy and radiation that causes severe side effects in 90% of patients.  ITA negotiated discounts on that treatment and on a costly anti-nausea drug that Robert otherwise couldn’t afford.  With minimal side effects, he completed treatment without delay or hospitalization.  All traces of tumor gone, doctors then recommended brain radiation to reduce the chance of metastases.  Distraught over more treatment, Robert spoke with an ITA oncologist who’s a lung cancer expert.  ITA’s doctor took time to listen to Robert’s concerns and explained the radiation’s proven benefits. Robert agreed to the treatment with confidence and determination.

 “Carly,” 31, had three children, metastatic melanoma, and was given a few months to live.  She and her husband were desperate. ITA coordinated her care among four medical centers and a local oncologist, and identified a quality clinical trial that might extend Carly’s life.  ITA helped her enroll, and worked with her local doctor to stop prescribed treatment that would disqualify her.  Her ITA nurse provided ongoing emotional support as new brain metastases were found over the next 12 months, and was there to assist with the transition to hospice when Carly was ready.  “Leslie, my ITA nurse, is wonderful.  I love her.  When she calls, I jump in, telling her, ‘This is what I’m feeling.  Is it right?  Is it wrong?  What should I do?’ No other medical staff do this for me.” – “Carly,” September 2008

“Marsha” had surgery for non-small cell lung cancer. She lived in a rural area, and contrary to treatment guidelines, didn’t receive chemotherapy and radiation — in part because no one was coordinating her care.  When cancer was found again, Marsha had an extensive abdominal tumor.  Her insurer had recently contracted with ITA Partners, and Marsha was enrolled. ITA became a source of support for Marsha, who was determined to live her final days at home.  ITA secured a discount for hospice and conservatively saved $21,000 in avoided hospitalization fees.

“Logan,” 28, was searching out of state and out of network for answers to his stage IV, T-cell lymphoblastic lymphoma.   Doctors at a renowned academic medical center offered a $170,000 hope — five weeks of the new, more targeted, proton beam radiation.  ITA’s Chief Medical Officer consulted with an ITA Medical Advisory Board member, one of America’s top clinical trial investigators in radiation therapy.  As emotional as the case was, they believed Logan and his family deserved to know the National Comprehensive Cancer Network doesn’t recommended any type of radiation as standard therapy in this situation.  There’s no evidence, from any study, that it has any benefit.  Further, the radiation would be entirely experimental, and his health plan would not cover it.

 “Albert,” 70, was prescribed combination chemotherapy plus Avastin, a drug that interferes with cancer cell growth.  ITA’s treatment plan review showed no studies indicating Avastin — which would increase the chance of side effects and cost $82,000 — was appropriate for Albert’s bile duct cancer. ITA’s Chief Medical Officer spoke peer-to-peer with his physician, who cancelled the Avastin.  Five months later, when Albert had severe neuropathies from chemotherapy, ITA worked with the attending physician to help arrange different treatment and avoid irreversible progression of side effects.

 “Dean” had recurrent head and neck cancer, with a tumor erupting from his neck.  Staff at a respected academic medical center had done little to teach Dean and his wife about tumor care, and hadn’t mentioned the tumor’s potential to cause sudden, massive vascular bleeding.  ITA filled the gaps.  ITA validated two clinical trials, facilitated enrollment, and ensured trial sponsors covered appropriate costs.  Dean’s ITA nurse taught his wife how to care for the tumor, and his wife even took charge when he left the hospital, “bloody and traumatized” after staff incorrectly removed his bandage.  Despite a tracheotomy and increasing complications, Dean’s wife successfully cared for him at home throughout his final months.