Cancer remains the second leading cause of death among U.S. adults after heart disease, with more than 1.75 million new cases reported in 2019 and 599,589 deaths from the disease, According to data from the Centers for Disease Control. From diagnosis to remission, cancer is a complex disease that can be difficult for people to navigate.
To help employees cope with a cancer diagnosis, many self-insured employers are turning to innovative programs that seek to balance the need for evidence-based care with the need to manage costs.
These costs are increasingly challenging for self-insured employers, who pay about 85% of medical health claims. However, Buck pointed out that because some members have more complex conditions than others, the costs are not distributed evenly across the program population. That difference goes well beyond the classic 80/20 rule, she said: 8% of employees cover 80% of health care costs. The claims are getting bigger and bigger. Buck noted in her presentation that the average cancer bill per high-cost claimant was $170,126. But she said claims of $1 million or more have risen 31 percent since 2017. Contributors include specialty medications, which make up 18 percent of the health plan’s total cost. Newly marketed drugs that extend the lives of patients present additional challenges.Cell therapy, gene therapy and immunotherapy are the most anticipated new drugs that can
Carrying costs are $1 million or more, according to Buck’s presentation. At the same time, companies are increasingly focusing on the right healthcare. In a survey of self-insured employers with 1,000 or more employees, Barker noted that 45 percent said they view healthcare strategy as an integral part of their workforce strategy, up from 20 percent in 2018. 27%. About a quarter said they would not wait to change the traditional health care delivery system and are ready to partner with innovators and actively drive change.
Although cost is a challenge, it is only one aspect of disease treatment. Coping with the stress of an illness that takes time to treat and recover and the impact on home caregivers requires a multi-faceted approach to provide patients and their families with the resources they need.
Dr. Mary Kay O’Neill, a partner in Mercer’s holistic health management practice, observed a trend toward integrating all services that touch cancer patients and their families, from screening, testing, second opinion counseling and treatment to services such as behavioral health. Screening services are an important topic for employers’ programs because preventive care can help identify cancer at an early stage, when treatment may be more effective, if not impactful.
“Being a cancer patient is a very exhausting thing,” O’Neill said. “There is a growing recognition that people whose family members are undergoing radiation therapy may need to take time off Tuesday afternoon to drive their family members for treatment — providing support in that way,” O’Neill said. “There is a growing effort to get people in touch to local resources that may often help with transportation and other services.”
O’Neill said that by National Health Business Group In partnership with the American Cancer Society and Johns Hopkins, there is some guidance for companies on how to think about cancer in the workplace.
An indirect effect of Covid-19 is that many people are delaying regular cancer screenings, such as breast, colon and prostate cancer. Delays can have an impact on employer costs: a recent survey In a survey of large employers by the National Health Business Group, which focuses on large employers, 68% of employers said they expected a higher prevalence of advanced cancer in their population due to screening delays.
An advantage for employers is that people of working age are less likely to develop cancer. Therefore, at any given time, people with cancer tend to mirror a small group of company employees.
Although small in number, these cases can be devastating. This has prompted employers to look for vendors who can offer innovative cost management solutions, among other steps, Buck said in an email response to questions.
“We are seeing employers looking to solutions from commercial operators and third-party providers outside of the traditional healthcare system to address the complex needs of the employer health plan population. Examples include AccessHope, cancer careAetna’s transformational oncology care, employer direct healthcare,” Buck said.
Aetna and CVS Health formed Transforming Oncology Care In 2019, as a joint team of experts across the business. The goal is to help newly diagnosed cancer patients more easily navigate complex areas of service and treatment, including prevention and screening, diagnosis, treatment, survival and supportive care.
transparent is another company that meets the needs of employers in cancer care and other areas of healthcare. Matt Meyanathan, head of oncology care Transcarent solutions, said the benefits most employees use on a daily basis don’t always increase awareness and utilization of traditional employer-sponsored cancer programs. This often leaves members receiving a life-changing cancer diagnosis scrambling to find relevant benefit plans.
“Furthermore, employer-sponsored cancer programs sometimes include isolated components, such as second opinion services or centers of excellence. Such programs do not talk to each other and are presented immediately, regardless of the specific needs of members in the course of treatment,” Meyanathn said. “Transcarent has integrated its oncology care plan into everyday care solutions, so members know where to turn to for guidance and resources about cancer when needed. This weaving approach gives Transcarent more opportunities to increase member awareness of benefits and Engagement, including increased cancer screening rates, which in turn can help providers diagnose cancer faster.”
Transcarent’s oncology program supports all cancer types, but initially focuses on cancer types prevalent in employer groups, such as breast, prostate, colorectal and lung cancer. Transcarent also offers a virtual care option, a common tool used by many employer plans since the start of the Covid-19 pandemic. These services provide support and guidance that can take the stress out of some long-term illnesses and can have as much of an impact on the health of cancer patients and their families as the treatment itself.
They also meet the changing expectations of employees after Covid-19. They want to be able to work remotely. They expect strong, accessible health care benefits.
“Employees expect more comprehensive benefits to help them meet their conditions,” admits Meyanathan. “Covid has expanded employee expectations for convenient, virtual or in-person visits and great experiences.”
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