Addressing Cancer Risk Through Proactive Care
How can employers reduce costs and provide benefits to their employees?
For employers taking health insurance risk through self-funded plans, cancer care costs represent a significant challenge — and a significant opportunity. Cancer is one of the most costly catastrophic conditions, representing almost 30% of employers’ stop-loss claims. In addition, cancer represents 37% of $1,000,000+ paid medical claims. The average cancer case represents hundreds of thousands of dollars in risk to an employer.
The survey responses reveal areas of opportunity to address these costs. For example, many participants expressed delayed care because of mismanagement in the first weeks after diagnosis. As an example, one patient (who carried heredity risk but did not have cancer) told us that her primary care provider referred her to an oncologist for high-risk screening. When the patient arrived, the oncologist told her that she wasn’t the appropriate referral.
Unnecessary appointments are an example of a care navigation breakdown that can drive real anxiety for the employee and real costs for the employer.
Market research suggests that when faced with a life altering medical diagnosis, consumers care about management, clarity, and control. What will consumers use, and, more importantly, what will they use to guide better care utilization? Over 70% of those surveyed would have leveraged a care navigation resource if available. Our respondents were motivated health care consumers, who, for various reasons, felt underserved by the resources in place. The reports they provided shed light on what would have helped.
Moving From General to Specific Proactive Care Approaches
“Initially, for every appointment, I had to call the customer service line from my employer’s benefits office. It was really frustrating. There was a different person every time, so each time I had to go through the same story.”
— Research Participant
Many employers have put in place wellness programs designed to reduce healthcare costs by promoting more healthy lifestyles among employees in accordance with HIPAA, GINA, and the ADA. Some employers are starting to address more specific conditions using indicators for heart disease and diabetes.
There are no one-size-fits-all solutions in healthcare; a direct approach to specific conditions is necessary. Cancer is one area where we can provide tools to ensure that appropriate care is accessible and timely.
It is important to remember that health care is inherently personal. While employer efforts to make care more efficient like on-site primary care are worthwhile, they are often general and will not be specific enough for beneficiaries with complex medical concerns.
Employers can save money by shifting cancer care upstream, where prevention and early detection are possible. Twenty-four month cancer treatment costs are 100% higher for cancers when first detected at Stage III than when first detected at Stage 0.
Providing Care Navigation Resources
“Coordinating care is overwhelming. It is frustrating and scary. Hard to wrap my head around, disbelief, swimming in a wide area with no landmarks.”
— Research Participant
As we have seen, lack of care engagement can have a significant impact on medical costs. However, for employers, this is only part of the story. Many cancer patients suffer from other conditions such as depression, chronic fatigue, obesity, anxiety, chronic back or neck pain, high cholesterol, and hypertension. Furthermore, loss in productivity costs can equal or exceed direct medical costs.
Respondent feedback is consistent with respect to care navigation. Patients feel overwhelmed and lost when given no clear direction at the time of diagnosis.
This is a major point of feedback and one that’s easily addressable. For individuals with hereditary cancer risk, we know up front what care options each person has and what the milestones will be along each route. Therefore, employers should be equipped to make available to their insured populations tools that:
- Assist with research and decision support to cut down on time and anxiety
- Provide care plan road maps for planning and peace of mind
- Provide support to help address burdens such as mental health and fatigue
The opportunity for employers to reduce direct as well as indirect costs is significant.
Coordinating With Local Providers
“Confusing and frustrating both from medical providers and insurance. When you are dealing with something as stressful as this diagnosis, having to navigate the medical world on your own can be overwhelming.”
— Research Participant
When asked what feature they would like to see in a care navigation platform respondents’ top choice was a targeted list of in-network doctors and specialists. A lot of time is spent trying to sort through the maze of potential specialists and their gatekeepers.
As indicative of this problem, respondents described frustrations such as contradictory information coming from various physicians (even within the same health system), appointment delays of six months, and improper prescription instructions. When these types of things happened, respondents were more likely to schedule multiple follow-up appointments, and spend three hours or more sorting out the confusion.
One way to tackle these issues is to coordinate with local providers for specific conditions and services. Rather than duplicative and costly appointments, for example, employers can direct enrollees with specific questions to the appropriate clinicians and clinical settings.
Emphasizing screenings as an option
“I feel like no one is in charge and there are no set recommendations. I would love someone to tell me what screenings I should have and when.”
— Research Participant
We know payers are putting a lot of effort into behavior change as a tactical approach to reducing care costs. For example, a typical wellness program will have smoking cessation and cholesterol reduction programs. The benefit for employers is lower costs. In cancer too, early detection is associated with much higher survival rates and lower costs. Employers should emphasize and make available appropriate screenings in accordance with current clinical guidelines.
The key for employers to remember, judging from the responses we received, is that carriers often use basic age-based algorithms that may deny coverage for screenings for high-risk patients. Many respondents shared stories of the countless hours spent appealing unnecessary denials. This is not to suggest a broad screening approach, but rather an approach focused on risk.
How can healthcare providers improve patient outcomes and satisfaction?
Because reimbursement is increasingly tied to value-based payment mechanisms, health systems have millions of dollars of revenue at stake and a significant incentive to ensure patient satisfaction. (Satisfaction scores often count toward payers’ definitions of value.)
Furthermore, providers are embracing value-based models and adopting strategies that, for instance, shift care to outpatient settings, support consumerism, and focus on retail partnerships. To bridge the transition gap, providers must concentrate on capturing attainable volume. Below we share actionable strategies for healthcare providers.
Leverage care navigation resources for business development
“Way too many tests and not enough doctor coordination. Too many incompetent medical personnel.”
— Research Participant
In our sample, many patients find a new health system for at least part of their care. In follow-up interviews, many of these patients cited communication-related issues as the reason for changing or supplementing care teams, including poor physician office information flow, ignored voicemails, and insurance denials.
A patient leakage rate of over one-third represents millions of dollars in lost revenue. Couple that with the fact that over 70% of any patient population feels overwhelmed by managing their own health care, and there is a significant opportunity for providers to gain a competitive advantage by easing the burden all patients feel.
Simplify and Coordinate Information Flow
“I didn’t receive information from any of my doctors. Sometimes I felt like I had to update them. The online portal was ok but it didn’t have much information and each doctor had a separate version, so it wasn’t coordinated.”
— Research Participant
Most health systems use some type of patient portal, which is often a module available from the EMR. Much of the surveyed patient population was young at the time of their diagnosis, and 66% of them used online resources as the primary source of information. Based on these findings, patient portals appear to be a good start for provider-directed communication.
Some respondents in our survey reported getting reams of paper in the early stages after diagnosis. This is problematic for two reasons: first, the format is not easily portable; second, it’s provided at a time of acute stress and, therefore, less likely to be fully understood and useful to the patient.
Providers should address communication challenges by offering mobile and online resources that are accessible to patients in an interactive and relevant manner.
The lesson here, however, is that providers should not simply scan material for distribution via a portal. (A 100 page PDF is not much more useful than a 100 page binder.) Unpack paper information into a process that a patient can follow at a self-guided pace. This will help health systems reach more patients as well as provide more engaging hard copy and in-person resources where it is necessary for or preferred by the patient.
Providers may use this opportunity to address another problem: inconsistencies in physician guidance. A surprising number of patients spent the first months post-diagnosis sorting through misinformation. One patient was told to discontinue contraception and another was told hormone therapy wasn’t an option.
Wrong in each case, this type of medical guidance can have serious repercussions and, in any event, interfere with the pace and efficiency of care — especially as patients make multiple appointments to try and sort out the facts. A one-stop-shop for specific patient sets allows a health system to manage care using consistently applied best-practice guidelines.
Educate and Equip Physicians to Make Appropriate Mental Health Referrals
“Most of my physicians had difficulty providing a mental health recommendation and when I did get a referral it was to person that didn’t have experience with patients like me.”
— Research Participant
We heard from respondents (especially in one-on-one conversations) about the need for targeted mental health resources. Getting diagnosed with a genetic mutation that predisposes you to cancer, they told us, is not like getting diagnosed with cancer, but it’s close.
That is significant. These people are faced with life changing decisions. Many have lingering mental health issues that they’re having trouble addressing. We asked why and our respondents cited two reasons: first, mental health referrals could take weeks; second, the mental health specialists didn’t understand the specific needs of the patient.
This is the third post in MyPeople Health CEO Alex Vealitzek’s series “Behavioral insights from patients shed light on opportunities for addressing cancer risk through proactive care,” taken from his recent white paper of the same name. Each week, HEALTH TRANSFORMER will publish a new post in this series.
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