How employers can increase the value of cancer benefits

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When an employee or family member is diagnosed with cancer, they face anxieties and fears about the financial, emotional and practical implications of this life-changing finding. A new report from the Northeast Business Group on Health offers employers guidance on how to help patients get higher value clinical care for the dollars spent on treatment.

“We decided to do the research and produce this report because cancer as a medical condition has become increasingly complex to diagnose and treat,” says Dr. Jeremy Nobel , director of NEBGH’s Solution Center. “In addition, the emotional challenges associated with cancer’s identification and treatment cycle are unique.”

With cancer care representing 12% of the total healthcare premium spend, despite only one to two percent of the population having that diagnosis, Nobel agrees that the accelerating cost of cancer care is also very real concern for employers.

To increase the efficacy of clinical care, the report recommends steering patients to high-value care sites in appropriate circumstances; ensuring the availability of second opinions; and, educating employees about the benefits of palliative care early in the treatment process.

Networks offered by health plans in their contracts with employers typically encompass a range of cancer care providers at hospitals or other community facilities, but some specialty centers are recognized or self-identify as “cancer centers of excellence.” The report suggests that depending on factors such as the stage and complexity of the cancer, geographical proximity and benefits coverage, directing employees to one of these COEs may be fiscally responsible.

Furthermore, Nobel believes that second opinions are more important than ever. “A proliferation of different treatment strategies, genomic medicine and a range of other breakthroughs can not only confirm the diagnosis but help to identify the most beneficial treatment pathway,” he says.

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Many cancers are treatable, but the word “palliative” evokes images of end-of-life care. In fact, the report characterizes palliative care as “specialized clinical care that focuses on providing relief for the symptoms and stress of serious illness.” Yet because palliative care is often confused with hospice care, it is delivered later than optimal in the cancer journey.

“Palliative care is provided in the hospital, ambulatory, or home setting during any phase of a patient’s illness, even during active treatment such as chemotherapy or radiation therapy,” Nobel explains. “However team members can help with transfer to hospice care, if needed.”

How can benefit professionals provide help when it comes to steering employees towards high value care? Nobel offers two suggestions: First, communicate to anxious employees in the pre-diagnosis or after diagnosis stages the full range of supportive services available through their benefit plans including programs that will help them with financial complexity management.
Second, work with the plans, and in some cases directly with the delivery system to ensure rapid and effective access to those systems that have demonstrated ability to deliver high quality results.

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“We will know we’ve done good work in this field when over the next few years we begin to see our employer members have a similar level of confidence when it comes to offering high value benefits to cancer patients as they now have in regards to other clinical conditions like orthopedics or cardiovascular diseases,” he concludes.

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