Situation
The journey to treat cancer is arduous, complicated and expensive. Cancer care is the highest spend category for high-cost claimants in many employers’ health plans. Effective cancer care is a function of three key variables:
- Timely discovery – early stage cancers are easier to address
- Right care team – deploying the right resources leads to better outcomes at lower cost
- Right support – providing additional member support helps the patient and their family through the process
In this second installment, we address the importance of choosing the right care team. As with all complex health episodes, using the most appropriate care team dramatically increases the probability of a better outcome and cost-effective treatment.
Complication
Unfortunately, despite the importance of making informed decisions when selecting a cancer care team, it’s difficult for employers to ensure members are getting the best care. Suboptimal cancer care can include having the wrong care plan and overtreatment, e.g., unnecessary chemotherapy that induces avoidable toxicity, unnecessary surgeries and radiotherapy. The consequences can be devastating – lower probability of survival, more complications, extended periods of uncertainty and fear. Therefore, it is critical to direct employees to the best possible provider in their local area.
Said differently “If your employee gets ovarian cancer and they live in Oklahoma City, how do you enable them to make the best choices for their care?”
There are 3 primary challenges to overcome:
- Cancer is not a single disease; care for cancers varies substantially across practices
- Information needed to evaluate trade-offs among various practices is not readily available
- Members are challenged to evaluate trade-offs
1. Cancer care varies substantively across practices. There are multiple sources of care variation and cost inflation in cancer care. To name a few:
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- There are more than 50 different types of cancer – not every practice is excellent at treating every cancer
- New treatments are emerging all the time – Are they relevant? And if so, are they available for your employees to access?
- Leading facilities have greater access to new treatment technology – these facilities also cost more even for cases where this new technology is unnecessary
- The cost of the exact same cancer drug can vary widely depending on site of-care
Experts will not agree on the relative impact of these factors. It doesn’t matter. The point is choosing care team A vs. care team B can make a dramatic difference in quality of life and cost of treatment.
2. The information needed to evaluate the trade-offs is not readily available. We asked experts about ways our clients help their employees make better choices. Not surprisingly, their first response was that often, the information to make better choices is not readily available. To aggregate all of that information in order to address all the possible employee situations would be an immense research project.
3.Members are challenged to evaluate trade-offs. Some cancer patients do not wish to be deeply engaged in information gathering and decision-making. The decisions around cancer care are complex (even for people who might have clinical backgrounds!) For example:
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- For this dangerous surgery, how many surgeries per year means a physician is sufficiently experienced? (And which surgeons meet that threshold?)
- For this cancer, is it important to find a physician with Academic expertise?
- If oncologist A has more experience than oncologist B with a particular type of cancer, is it worth traveling farther for oncologist A?
- Is access to novel treatments or clinical trials important for this type of cancer? If so, which hospitals and doctors are likeliest to provide this access?
Solution
Add specialized resources to your health plan. Fortunately, self-insured employers have the opportunity to augment the resources available in their health plan. And, there are companies that have done (and continuously update) the immense research needed to provide employees with the information and insight to make well-informed choices. Wellnecity has partnered with Cancer Study Group to provide employers and their employees access to this mission critical insight and empathetic coaching.
In fact, because we think this enhancement to healthcare management is so essential, we have made it part of our Better Care Bundle, a set of important capabilities that we bring when clients deploy us to improve how their health plan operates.
You might ask (if your health plan has an oncology Center of Excellence program), doesn’t my health plan already do this? The answer is: if yes, not well enough. Why: the level of research to do the work right is not the type of overhead that every health plan (even the biggest) want to take on. And, health plans have to be very careful not to offend their provider partners, so making the hard choices like not recommending the name-brand local provider, are challenging.
Wellnecity Example
Wellnecity’s standard claims dataset gives us timely access to new cancer diagnoses among a member population. Our research indicates that about 0.6- 0.7% of a population will have a new cancer diagnosis each year (per thousand members, this comes to about one new cancer case every 2 months).
When we see a new cancer diagnosis trigger in claims, Wellnecity immediately notifies Cancer Study Group of the member’s new diagnosis. At that point, Cancer Study Group’s Oncology-Certified Nurse Navigators proactively reach out to the member to offer empathetic support and guidance, rather than waiting for these often confused and stressed members to call an 800 number to get help themselves.
As such, Cancer Study Group has found targeted individuals are very receptive to help. In fact about two-thirds of the members Cancer Study Group contacts accept delivery of a custom Research Brief from them. The Research Brief is delivered in two days or less, and includes evidence-based guidance and education about the member’s condition in understandable, lay-person terms. Critically – the Research Brief outlines tailored information on how to find a great care team for the member’s particular type and stage of cancer along with options for cancer centers nearby along with their relevant case volumes and metrics.
The patient and/or their caregivers ultimately make the final decision on care team, enabled by the timely and accurate information they need to do so. Through the whole process, they are supported by a qualified oncology nurse who helps gather records, answers questions, and handles logistics like appointment scheduling. An illustration of how this process works is below:
For past insights, visit us at: https://wellnecity.com/insights