Cancer remains the second-leading cause of death for adults in the U.S. after heart disease, with more than 1.75 million new cases reported in 2019 and 599,589 people passing away from the disease, according to data from the Centers for Disease Control. From diagnosis to remission, cancer is a complex condition that can be overwhelming 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 evidence-based care with the need to manage costs.
These costs are increasingly challenging for self-insured employers, which pay roughly 85% of healthcare claims overall, according to a 2021 presentation by Dr. Shealynn Buck, Chief Medical Officer with Lockton, for the National Cancer Institute on employees and cancer care. However, the costs are not distributed evenly over the plan population since some members’ conditions are more complex than others, Buck noted. The disparity goes well beyond the classic 80/20 rule, she said: 8% of employees account for 80% of healthcare costs.
Claims are growing in size. The average cancer cost per high-cost claimant is $170,126, Buck noted in her presentation. But claims of $1 million or more have increased by 31% since 2017, she said. The contributors include specialty drugs, which drive 18% of total health plan expenses. New-to-market drugs that increase patient lifespans pose even more challenges. Cell, gene therapy and immunotherapies, which are among the most anticipated new drugs, can carry costs of $1 million or more, according to data from Buck’s presentation.
At the same time, companies are increasingly focused on getting healthcare right. In a survey of self-insured employers with 1,000 or more employees, Buck noted that 45% said they consider a healthcare strategy as an integral part of their workforce strategy, compared with 27% in 2018. About one quarter said they would not wait for the traditional healthcare delivery system to change and are ready to partner with innovators and become active in driving change.
Although cost is a challenge, it is only one aspect of disease treatment. The stress of coping with an illness that will take time for treatment and recovery, along with the impact a cancer diagnosis has on family caregivers, requires a multifaceted approach to give both patients and their families the resources they need.
Dr. Mary Kay O’Neill, a partner with Mercer’s total health management practice, observed that one trend has been to integrate all the services that touch a cancer patient and their family, from screening, tests, second-opinion consults and treatment to services such as behavioral health. Screening services are an important theme of employer programs as preventive care can help identify cancer in earlier stages when treatment could be more effective, if no less impactful.
“It’s a totally consuming thing to be a cancer patient,” said O’Neill. “There’s increasing understanding that maybe a person whose family member is having radiation therapy may need to take Tuesday afternoons off to drive their family member to treatment — to be supportive in that way,” O’Neill said. “There are increasing efforts to get people in touch with what are often local resources that may help with transportation and other services.”
O’Neill said work undertaken by the Business Group on Health in conjunction with the American Cancer Society, and John Hopkins, offers some guidance to companies on how to think about cancer in the workplace.
One indirect impact of Covid-19 is that many have delayed regular cancer screenings such as for breast cancer, colon cancer and prostate cancer. The delays could have an impact on employer costs: A recent survey of large employers by the Business Group on Health showed that 68% of employers said they anticipate higher prevalence of late-stage cancers in their population due to delayed screenings.
One advantage for employers is people of working age are less likely to develop cancer. Thus, at any one time, people with cancer tend to reflect a small minority of company staff.
While small in number, the cases can be disruptive. That is driving employers to seek out vendors that can provide innovative cost-management solutions, among other steps, Buck said in an emailed response to questions.
“We are seeing employers looking to solutions provided by commercial carriers and third-party vendors outside of the traditional health system that address the complex needs of the employer’s health plan population. Examples include AccessHope, CancerCARE, Aetna’s Transform Oncology Care, Employer Direct Healthcare,” said Buck.
Aetna and CVS Health established Transform Oncology Care in 2019 as a joint team of experts across their businesses. The goal is to help newly diagnosed cancer patients more easily navigate the complex terrain of services and treatments, including prevention and screening, diagnosis, treatment, survivorship and supportive care.
Transcarent is another company addressing employer needs in cancer care and other areas of healthcare. Matt Meyanathan, Transcarent Solutions Lead, Oncology Care, said the benefits that most employees use on a day-to-day basis do not always build awareness and utilization of traditional employer-sponsored cancer programs. That often leaves members who receive a life-changing cancer diagnosis scrambling to look up relevant benefit programs.
“Further, employer-sponsored cancer programs will sometimes include siloed components, such as a second-opinion service or a center of excellence. Such programs do not talk to each other and are presented all at once regardless of a member’s specific need during a treatment journey,” Meyanathn said. “Transcarent has integrated its oncology care program into the everyday care solution in such a way that members know where to turn to for guidance and resources on cancer if and when they need them. This woven approach allows for enhanced opportunities by Transcarent to improve members’ benefit awareness and engagement, including driving up cancer screening rates, which in turn, can help providers diagnose cancer sooner.”
Transcarent’s oncology program supports all cancer types but initially focuses on cancer types prevalent within the employer population, such as breast cancer, prostate cancer, colorectal cancer, and lung cancer. Transcarent also offers a virtual care option, a general tool that many employer programs have embraced since the start of the Covid-19 pandemic. The services offer support and guidance that can remove some of the stress of a long-term illness and that may make as much difference to the health of cancer patients and their families as the treatments themselves.
They also match the changing expectations of employees in the wake of Covid-19. They expect to be able to work remotely. And they expect strong, accessible healthcare benefits.
“Employees expect more comprehensive coverage with benefits that help them on their terms,” Meyanathan acknowledged. “Covid has expanded employees’ expectation of convenient, virtual or in-person access with an excellent experience.”
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