In this panel, HR and benefits leaders will explore how employers can better support employees managing chronic conditions — not just through healthcare plans, but through flexible policies, wellness programs, and a workplace culture that prioritizes health and well-being.
Discussion topics include:
- The role of flexibility: remote work, adjusted schedules, and expanded leave
- Designing chronic care-friendly policies that go beyond compliance
- Supporting managers in delivering individualized accommodations
- Fostering a culture where employees feel safe using the resources available
- Using wellness coaching and financial tools to empower employees' health journeys
Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.
Alyssa Place (00:14):
Hi everyone, and welcome to Lead the Shift: Next Gen Benefits Strategies that Work. I'm Alyssa Place, editor-in-chief of Employee Benefit News, and on behalf of our team, I'm so glad you're joining us today. As the workplace keeps evolving, HR and benefit leaders are rethinking what it really means to support their people and their organizations. Over the next few hours, you're going to hear from leaders and innovators who are shaping the future of benefits from flexible wellbeing programs and inclusive policies to new tools like AI-powered mental health support and GLP-1 treatments. Before we get started, there are a few housekeeping notes. First, I'd like to thank our sponsors for this event, Bright Horizons, Private Health Management, Revive, and ShelterPoint. Also, this event is SHRM certified for up to 2.75 PDCs towards SHRM, CP or SHRM SCP recertification. In order to qualify, you must attend for the full duration as attendance is monitored and recorded.
(01:12):
If you have any questions on how to obtain your credits, please refer to the event website, the main page of the attendee hub, or send a message directly to Heather Megan who will be manning the Q&A chat. Activity ID numbers and certificates will be mailed out two weeks post-event. We will plan to take questions during the sessions, but we're going to hold responses until the end of each session. If you have any other questions or need help, please use the Q&A chat and be sure to include your name rather than asking questions anonymously. Thank you again for joining us today. We're so glad you're here. Let's dive in and get inspired by the new ideas shaping the future of work. We're going to get started with our first session, so over to our moderator and EBN Editor, Lee Hafner.
Lee Hafner (02:12):
Good afternoon, and thank you so much for joining us today. We are getting into our first session, Building Chronic Care into Benefit Strategy: How Employers Can Support Chronic Disease Management for Better Health Outcomes. I'm Lee Hafner, editor at EBN, and it is my pleasure to introduce our experts for today's panel, Natalya Gertzick, Vice President Partnerships at Private Health Management, Stephanie Perino, Director of Human Resources at Hendry Marine Industries, and Chris Smith, Vice President of Benefits and Wellbeing at Universal Music Group. Thank you so much for joining us today. Chronic conditions such as MSK, heart disease, cancer, diabetes, and autoimmune disorders now affect the majority of the employee population. As people increasingly look to their employers for health and wellness support, identifying best practices for benefit design and communication and people-first policies along with an empathetic culture will be key to helping people and businesses achieve the best outcomes. As our panelists are speaking, please feel free to drop questions into the chat.
(03:17):
Also, if you would like a particular panelist to answer it, please put their name along with your question. Do this at any point during the session and we'll be getting to those questions at the end. Natalya, following a description of what PHN brings to employers, why is chronic care such a critical focus for benefit leaders right now?
Natalya Gertsik (03:45):
Yeah, thank you. We are focused on the most serious cases at PHM, the 3% of claimants driving 50% of healthcare spend. The reason this population is so important is because, believe it or not, these cases are becoming more and more expensive. It used to be that about 3% of cases were driving about 30 to 40% of spend just a few years ago. Now it's 3% driving 50 to 60% of spend. Million dollar claims are up 50% over the past four years, and the highest cost condition is cancer by far. It has about three times more spend associated with it compared to the next highest cost condition, and that's if you consider both liquid and solid tumors. This was from a Sun Life report that came out recently. This is the reason healthcare trend is growing in double digits. It's the reason employers and advisors are desperately seeking solutions that will stop the bleeding because there's almost no limit to how expensive some of these cases can get.
(04:51):
At PHM, we don't aim to be all things to all people. We're not broad navigation. Rather, we are a highly specialized SWAT team that runs into the burning building of serious and complex conditions when everyone else is running out. What are the conditions that fit this mold? They're serious, they may be chronic, they may have an acute component or both. They're expensive or at risk of becoming expensive. It's really two broad categories, at least the way we look at it. One is cancer. 40% of our business is cancer, and almost all cancers are good candidates for PHM because they're serious and complex by nature. There's a few exceptions like non-melanoma skin cancer, which is simple enough to be well managed in the traditional healthcare system, but most cancers, even stage one, are serious and complex. 60% of our business is that other bucket, everything else that can wind up on your high cost claimants report: neurological, cardiovascular, musculoskeletal, immune-related, pediatric, rare conditions.
(05:55):
The benefit of this approach is that our employer clients don't need to engage a separate point solution for each disease because we're providing support for the full spectrum of serious conditions. I want to mention one more thing, which is what are some of the gaps that PHM closes? There's actually many. We all know it from our own personal experience navigating the healthcare system, there are many gaps that a patient can fall through or may have trouble navigating or that just aren't designed to optimize for better patients care. But I want to talk about one, which is the lag in adoption of novel clinical interventions. Over the past two decades, we have witnessed extraordinary medical advancements, particularly in oncology, but really across many other fields of medicine. However, healthcare providers and systems have not kept up. As a result, the treatments that are often available FDA approved today are actually not being delivered to patients with serious conditions or at least not being delivered to the right patient at the right time in the right dose.
(07:02):
I'll give you one example. 80% of patients with active cancer fail to receive the molecular diagnostic testing that is required to accurately diagnose their disease and is required to establish an optimal treatment plan. Instead, and these tests, by the way, they're maybe $1,000 a pop. Instead of that, physicians use more of a trial and error approach. We'll try first line, second line, third line therapy, all these different drugs one after another to eventually find one that works. The downside of that is that at $70,000 a pop on average for these oncology drugs, that's an expensive experiment, and it's even worse for the patients who experience all of the side effects and none of the benefits of the drugs that aren't working for them. There is a better way. By leveraging precision medicine, we can identify exactly which therapy has the highest likelihood of success from the outset so that we use the right interventions, therapeutics, drugs from the beginning so that a patient can have the best possible clinical outcome, but also that the plan uses only the interventions that are ultimately going to be beneficial to the patient rather than ones that are maybe inappropriate or even harmful.
Lee Hafner (08:17):
Thank you. I love your analogy of the burning building. So backing up from the people that are absolutely going to need this high level of care, the conversation around preventative care has grown tremendously. Stephanie, you've had a ton of experience incorporating this type of care and benefit structure within your company. Can you please share some examples of that and what success looks like at Hendry?
Stephanie Porrino (08:47):
Sure. Going back to some of the key elements of a successful healthcare strategy is really having access to data and not only having it, but knowing what to do with the data, knowing what lever to pull to have an impact on the population of your employees and their covered family members. When we started evaluating a few years ago just our utilization of preventative medication or preventative wellness visits, we had an oh-no moment because we realized that a very small percent of our covered members were using the preventative wellness appointment benefit. That drove us to start finding a solution that would provide access for our employees on site because if they weren't doing the basic fundamental things to take care of themselves, we knew that the outcomes could be extremely bad for them. That obviously causes productivity issues, it causes them not to feel well, and it impacts every part of their livelihood.
(09:59):
We came up with a solution to bring an onsite primary care clinic into the shipyard, and Hendry Marine is a shipyard. We have two operating entities with 300 employees, 80% of them are men in our workforce. Unfortunately, the numbers of utilization for the preventative wellness benefit really corresponded to our workforce demographic. So we were very methodical and thoughtful once we provided the onsite primary care clinic, we wanted to make sure that we provided them with the opportunity to go on company time. They don't have to pay for the clinic. And even though we intentionally wanted to provide the preventative wellness services originally, we've expanded services to include many more things. What we were seeing is that employees were starting to engage. We did have a little hiccup in the beginning, and I love telling this story because as an HR leader, we always learn lessons.
(11:07):
One of the biggest lessons I learned was when we found the onsite primary care clinic that we put on site back in January '22, I was feeling very optimistic because we had this resource for the employees and their family members, and I prepared what I thought was all of the Q&A that would cover everything that our employees would need to know. The one thing I did not consider was the perception or the optics that the employees had of why does the company want to know about my medical business? That was an aha moment I had. Quickly thinking on our feet, we said, okay, in order to get people to the clinic, we need to provide a benefit or something that would drive them to want to go. So we ended up doing a contest and we came up with a raffle idea. It was, if you go for your preventative wellness benefit between January and April, your name would be put in a drawing for one person to win five days of PTO, which is a huge deal.
(12:19):
We ended up getting a ton of utilization and through that contest where people were just trying to win PTO, we ended up finding two life-threatening diseases. In that moment, we knew we made the right decision and they became the biggest advocates for our onsite primary care clinic, sharing their success and what happened with their coworkers. Since then, it has been such a huge part of our culture from a recruiting and retention standpoint, and not only to mention that the employees are taking better care of themselves because they have continuity of care with the primary care doctor. It's really been a game changer for people inside of our yard. It also includes family members that are covered on the healthcare plan as long as they're 16 or older. We have expanded those services and we've really just seen such a tremendous utilization of it and it's just been the best project that I've ever worked on.
(13:20):
Every year we do make sure that we have an ROI on that investment because it is a large financial investment, but on the backend of it, we have employees that are seeking and getting the care they need on a consistent basis. They're being more productive because they're not having to leave work for half a day or a full day. Overall, they're taking much better care of themselves. It has really just been a tremendous benefit for everyone.
Lee Hafner (13:49):
Absolutely. Chris, you also saw the need to bring in a form of preventative care specifically for cancer screenings through Color Health, who you partnered with. Can you talk a little bit about why that was something you felt was such an important addition to your offerings?
Christopher Smith (14:08):
Well, firstly, it's everything that Natalya said and everything that Stephanie said, the burning building and allowing the data and using the data to tell a story because the story was in the data. The story for me, now almost four years into being a part of Universal Music, and not to make this a morbid conversation. Yes, every year, most of us benefits people, at least once a year, we pour over the claims that are, of course, aggregated and anonymized for any of the legal and privacy people. I have no idea who's using what. We look at the state of our claims. We look at what's driving costs. We look at those high cost conditions. We look at those chronic cases and always on the list, as Natalya said, is cancer, almost always. For a lot of chronic conditions, there are more ready-made programs available.
(15:28):
You can take your pick off the shelf, yep, musculoskeletal issues, got it. Here's a program for that. In my time as a benefits person, whenever I got to a cancer claim or saw cancer conditions that of course cost sometimes thousands and thousands of dollars, not to mention the impact that it has on lives, I never knew exactly what remedy to put into place. What could I possibly do to sometimes support somebody through something that is often the case so random, but yet so impactful? What do we do? And I stumbled upon Color Health.
(16:14):
Before I get there, the other data point that I found alarming to say the least, Lee, was that over the past few years, I found that we had upwards of 15 deaths within the organization. The vast majority of those deaths were people who were less than 60 years old, and the vast majority of those deaths were cancer related. There's a story there. There's a sense of duty and responsibility there. Now, I haven't even gone into the whole ROI stuff yet, but there is a sense of duty and a sense of responsibility. What do we do in addition to all the other claims autopsy stuff? I stumble upon Color Health and what I liked about Color Health and what I like about Color Health is the following. Like most benefit plans, we offer preventative screenings covered at 100%. It's there for you. Go for it. We're working with our insurers to remind people, do this, go for it. But we're finding that still there has to be some barriers because not enough people are going forward. Why? The questions I ask are: is what we're offering accessible?
(17:52):
Is what we're offering equitable? Is it giving people equal access? Perhaps the most important pillar for me as a benefits person is, are the offerings that we are making available, are they easy for people to get to and to get through? Color Health for me checked off all of those boxes. What they set out to do, Lee, is they are not reinventing the wheel. They are not necessarily reinventing screenings. Yes, it is important for people to have colonoscopies. Yes, it is important for people to have mammograms, and this is the same sort of edict that Color Health is communicating. The game changer for me was, one, we are going to make sure that some of these kits, these screenings that we can make available to you at your doorstep, we're going to mail them to you. Not only that, we're going to engage you in a two to three minute questionnaire because I too have this new generation mindset that anything that's going to take me longer than three or five minutes to do, you're going to lose me as an audience member maybe.
(19:17):
This needs to be easy. In the questionnaire for me, I asked questions like, "Are you predisposed to cancer? What happens? What's your family? What have they been exposed to?" Through this questionnaire, me a benefits leader for over 20 years, I found that I needed to do a genetic test and I found that there was some abnormal activity in me that I am working with clinicians as we speak about, and those clinicians said to me, "This was a game changer that you got in here now." The third thing or the other component that I like about this Color Health program is the accountability aspect of it because in addition to making it easy, the questionnaire is asking you questions to really help you to figure out what it is that you need to do more proactively. I think all of us can understand on this call that the most potent weapon that we have on the fight against cancer is early detection.
(20:28):
It's so key. But what I also like, because I think I'm going to speak as a representative for perhaps a lot of men across America, I am terrible about following through with my appointments and meeting with my primary care physician. It takes people to really say, "Hey, you need to do this." That "you need to do this" accountability component also lives within Color because now you have advocates, an advocate that you are teamed up with who says, "Hey, we saw that you submitted the questionnaire. Great. We told you that you need to go to the doctor. Great. Have you gone? Have you done this?" That follow up and follow through helped me to what could have been or what could very well be a life saving measure.
(21:28):
This was my story, and I had to believe that this was the story of a lot of other people in the organization. Dare I say that maybe this could have been the story even for those 15 precious lives that we lost. Dare I say this also could be the story for what we have seen in our claims experience in that the vast majority of those who are now undergoing some sort of a more invasive form of treatment, we found that the vast majority of those had what was considered an impactable cancer diagnosis, which means maybe Lee, Just maybe if that person were to have that early intervention, if maybe they were to have that screening when they should have, maybe just maybe we wouldn't be here. That's not to chastise. That's a call for me and hopefully other benefits leaders to look at your data, let the data tell a story, share that story with your business leaders and look for solutions that can really help to bridge the gap in a way that's accessible, equitable, and easy.
Lee Hafner (22:49):
Thank you. So breaking down these barriers to care, as you and Stephanie have both done, this absolute focus on prevention, getting ahead of things, your own personal experience. Thank you for sharing that too. When we do get to the point where someone is in need of very acute chronic support, Natalya, coming in alongside an employer to support those people, why is that also such an important benefit to have in addition to the preventative things?
Natalya Gertsik (23:34):
Yes, absolutely. What we do is we wrap a clinically sophisticated personal care team around each individual with a serious or complex health condition. It might be a stage one cancer or it might be a stage four cancer, and that team is composed of an advanced practice clinician, a PhD scientist, and a care coordinator. This really enables us to marry clinical expertise together with logistical support and execution because you need to do two things incredibly well to impact these cases. One is you need to develop a fully optimized care plan, and the second is you need to actually execute on that plan. Part of this is that you can create a clinical plan. It might be great, it might be optimized on paper, but without the execution, it's pretty useless. It's kind of like a second opinion that you don't know what to do with.
(24:32):
Conversely, if you're navigating patients within the fragmented system and you're not putting them on a better clinical care path, you're sort of just navigating them in the existing system with their existing team, providers, care plan, et cetera, while all you're really doing is expediting mediocre care. I'll talk a little bit about the impact that is possible when you combine this incredibly deep clinical sophistication to put a person on the right, the optimal care plan, which is often different than the care plan they come to us with, together with executing on that plan locally for that person so they can stay close to home and they're going through possibly the hardest time in their lives. We change diagnoses 30% of the time. Right or wrong, a diagnosis determines everything that follows, and the worst treatment is treatment for the wrong disease. The reason we change diagnoses sometimes is because it was misdiagnosed when it came to us, like it was a lung cancer misdiagnosed as a thyroid cancer or vice versa, but more often it's because it was underdiagnosed.
(25:41):
There's not enough information about the clinical issue to make optimal treatment decisions. Now using precision medicine, what we can do is we can actually get an accurate and complete diagnosis. We can understand what is driving that disease at a molecular level so that we can precision strike it with therapies. We change treatment plans 70% of the time. This can be very significant treatment plan changes like from a mastectomy to a lumpectomy or vice versa. We can deescalate chemotherapy for a patient who didn't need it, or alternatively, we may recommend to add chemotherapy for a patient that has a high risk disease that has not been identified as high risk or erroneously identified as low or moderate risk. The most remarkable statistic is that there is a two to fourfold improvement in overall survival for late stage cancers for patients who come to PHM. What that means is that a patient who comes to PHM with a late stage cancer will live two to four times longer on average compared to a similar patient in the US population.
(26:49):
There are no recent FDA approved drugs that come anywhere near that survival advantage. In fact, most drugs achieve a couple of months survival extension and they cost hundreds of thousands of dollars a year. If we could bottle this up in a pill, it would be a blockbuster. It isn't magic, it's precision medicine. It's a testament to the fact that when you deploy precision medicine consistently and effectively, the impact on survival and quality of life can be profound.
Lee Hafner (27:22):
Absolutely. Stephanie, talking about looking at these other alternatives, these things to include within your care solutions that really add a whole other dimension of care and of change, can you talk a little bit about the importance of being very thoughtful about how to approach things like medication and what are some of the things that you have seen and done in order to make things more cost-effective, but also get people improved care along the way?
Stephanie Porrino (27:57):
Sure. The first thing is that when we look at our total healthcare spend, we really want to know how much of that spend is with our pharmacy benefit management company. It's actually looking at the healthcare financing piece. What percent of our overall spend is our pharmacy piece? What we have done in the last few years is we have partnered with a PBM that actually has several different components. It's not just that the member fills a prescription at retail and then you're paying additional cost for that retail fill. It actually is a broader range of resources. Yes, retail is still an option. Yes, mail order is still an option, but so are using international prescription filling, there's alternate funding, there's specialty funding. One of the things that we did with one of our medications, and this is a really good point to know if you're really digging deep into the claims information on the medical side.
(29:11):
Occasionally, and I found this with medication related to MS and a medication related to cancer, what I know them as is J codes. J code medication is typically sitting on the medical side of your healthcare plan, and occasionally you can shift it over to the PBM side. In our case, it was one for MS and we were getting billed $80,000 twice a year for each injection. What we discovered it was on the medical side of our healthcare plan, that's how it was being billed through an EOB. Once we discovered that, we were able to, after a few months, because there are conversations that have to go back and forth between the parties, we were able to speak with the site of care that was issuing the injection. They spoke with our TPA and our PBM, and we were able to shift that particular cost of the medication to the pharmacy benefit management company.
(30:19):
They in turn went and sourced it and were given authorization to what we call brown bag or white bag to the facility directly. It no longer allowed that infusion facility to source the prescription directly because that's where we were getting an increased price of about 500% above the actual price. That's why we were paying so much. So it gave the PBM an opportunity to source it, send it directly to the infusion center, and then we got funding for it. It reduced the price by over $100,000 for that one medication alone. Not only looking at the J codes on the medical side of the plan, but recognizing that if you are working with a traditional carrier, you may not be getting as much discount and you're probably paying a significant amount more than you need to if you were with an independent PBM.
(31:20):
One of the things I always give advice on to HR leaders when they're talking about their healthcare plan strategy in relation to pharmacy is if you're going to make a change, if you're thinking about going from fully funded to self-funded or you're with a self-funded plan, I believe that the easiest change you can make with little disruption is to change your pharmacy benefit manager. Typically your overall costs will be reduced by 20 to 30% the first year. Just so many options available. It's just keeping up with what's going on in the industry and hopefully working with an advisor that really understands cost containment and how that can have an impact on not only your organization financially, but how it's going to help have better outcomes for your members as well.
Lee Hafner (32:14):
Thank you. We could talk about the healthcare aspect alone of chronic conditions, I think all day, but also want to make sure that we talk about the comprehensive level of care that goes into helping employees navigate these situations. When it comes to things like the mental and emotional impact of this, financial impact, and just overall wellbeing for people, Chris, can you share some of your company's benefits that you've put a lot of thought into that come in on the side and really help support people holistically when they're dealing with any kind of condition like this?
Christopher Smith (33:03):
Lee, I love how you framed that because we have to remind ourselves that there are real lives that are impacted by all of these transactions, by all of the decisions even that we make as benefits leaders from our positions. I have seen firsthand through data, through absenteeism data, through conversations with employees, the real toll and impact that it has on not just a physical wellbeing, but the behavioral, emotional, and mental wellbeing. So some of the things that we have done to support people more holistically,
(34:03):
One, again, my whole thing with accessibility, equity, and ease is, are there any barriers to people being able to get to the behavioral health resources that they need? To speak to a therapist, for example, if you need to, to speak to a mental health clinician if you need to. Yes, the good old employee assistance program, which for us is pretty robust and more to come there, but also within our medical plan, we have essentially waived any copays to someone being able to see or to utilize any outpatient mental health services. For me, a small spend for a larger amount of impact. One thing that I encourage people to think about, and I don't want to seem like I'm lecturing because these are things that I continue to learn. I am a student at the end of the day with all of these experiences. I'm constantly learning. I think most benefits people will say that we are constantly learning because what was true a week ago may not be true today. I am learning the value of conversation. And not everybody wants to talk about what it is that they're dealing with. That's okay. But as you probably know, Lee, I am an open book, and so I have found that by sharing my story along so many different facets of my life and things that have happened, it has given permission for other people, based on what I've been told, for them to be able to show up and say, "Wow, it is okay for me to say that I have this need." Because to me, that is one of the greatest, most valuable pieces of data that I could get as a benefits leader is hearing from our employees about what their need is. Yes, we don't want to necessarily give the impression that we are going to be able to make a promissory note and deliver on everything that somebody asks, but it certainly helps you to understand what the need might be.
(36:38):
Because of these types of data inputs and feedback, it has really helped to inform and evolve our behavioral health support, and we're looking forward to doing more.
Lee Hafner (36:50):
That's awesome. Stephanie, you also really focus on things like flexibility, giving people the chance to use the resources that are provided without having to sacrifice necessarily their personal lifetime, or you just make it very simple for them to seek care, whether that be preventative or more serious. Can you talk a little bit about why flexibility needs to be unique to organizations and that one size doesn't fit all, and then what you do to make sure that your employees can seek care when they need to?
Stephanie Porrino (37:35):
Sure. One of the things that Chris said really hit home with me, and that is as HR leaders, we're always learning. The way I thought about healthcare a few years ago has totally changed to where I'm at now. It's really about meeting people where they're at, understanding your company culture, what kind of employees do you have? In our case, we knew that our workforce was not leaving to take time off to take care of themselves. That's why we created that access for the primary care clinic. It's really about the fact that as an employer and a planned fiduciary, a plan sponsor, you have a duty to deliver a benefit program to your employees that is going to really help them for their long-term health and wellbeing. It's up to us to make sure that we're continuing to communicate and make sure they know what access they have that the company's providing to make it a better experience for them.
(38:40):
Access is really hugely important. Even I had a really big mind shift a couple years ago about high deductible healthcare plans. I wanted to make sure that we weren't creating a situation where people were functionally uninsured because the deductible was too high for them to access care. So looking at that with our two healthcare plans, it's removing barriers on the base plan, adding in copayments so they can continue to go to the doctors and specialists and having access to medication. Again, it's just really about understanding your workforce, meeting them where they're at, and then creating that plan that will help support their long-term health for them and their family.
Lee Hafner (39:28):
Thank you. When you mentioned that you caught a couple very, very severe conditions for people, can you talk a little bit more about that for a second, just one or both of the examples?
Stephanie Porrino (39:46):
Sure. In one case, and again, both of these employees were trying to win the PTO, that's why they signed up to go for their preventative wellness check. Can't blame them. That's a huge reward. One of the gentlemen went in and the doctor said to him, did you know you had a lump in your neck? He had no idea and he had stage four cancer. Thank goodness he's alive and well and doing great today, but had that clinic not been there to help him, I don't think the outcome would've been the same. In the second case, we had someone again trying to win the PTO during that contest period that went in and his blood sugar was so high, he was almost at stroke level. catching things like that in a preventative situation is so impactful because we know we're helping them live a healthier life and we're going to help them get on a better trajectory to better health. It's been an incredible journey having them on site and the employees love it.
Lee Hafner (41:04):
That's tremendous. Natalya, just after all that's been shared, can you talk a little bit about when people interact with your company, what does that look like briefly as far as if I'm an employee and I have access to this benefit, what does that look like for me as far as how my care progresses with you?
Natalya Gertsik (41:37):
Yeah. I think the three-person personal care team is a big differentiator, having that clinical expertise that at least I'm not aware of other solutions that have the level of clinical expertise that we do. One of the biggest differentiators there is the PhD research scientist because our healthcare system is really not set up to deliver patients to the best possible clinical outcomes and clinical path. Rather, it's set up to follow standard of care and the average treatment plan that works for the average patient, by definition, nobody really is an average patient. Risk levels vary and preferences vary. A woman who is premenopausal may have very different preferences than the postmenopausal women, even if both have the same type of breast cancer, because a woman who is fertile and may want to have more children may not want to give that up as part of treatment.
(42:36):
Those are considerations that one really needs to think through. How do we treat this person optimally and preserve fertility or have their eggs frozen in time before therapy starts or during therapy? How do we design all of that to work for the patient? That's the personalized medicine piece. So I talked about the precision medicine, which is understanding the molecular disease drivers, understanding the disease at a genetic level, and really being able to drive to best care, best outcome. Then there's the personalized piece, which is that none of us are the same, even if we have almost what looks at the surface as the exact same disease, because we may have very different goals and risk tolerances for how much treatment we're willing or not willing to do because some of these cancer treatments, they're very intense and disruptive and can be really significant side effects.
(43:30):
Patients have to think through what is the right care plan for them. That's the personalized piece that we also really profoundly support in PHM. I'll just give you an example of some patients that we've navigated through because I think to Chris's point earlier, there's nothing like a story to make some of this really come to life. We had a patient with stage four prostate cancer and his doctor at a Center of Excellence that he was at told him he had just a few months left to live. His disease was metastatic and the doctor told him, "Look, you're out of options." This patient turned up at our doorstep. We ran a set of what at the time were cutting edge diagnostic tests and found that he may be a good candidate for what at the time was an experimental therapy called radioligand therapy.
(44:22):
The problem was it wasn't yet FDA approved, but we were able to find a clinical trial for him, which as you know, is covered by the trial sponsor and at least the investigational agent then is not billed to the plan. So it's a source of cost savings for the employer. We were able to identify clinical trial of this radioligand therapy, and it was unbelievable the results that he had. His disease melted away. He was completely cured of a stage four cancer, and eight years later, he's still playing with his grandchildren. That therapy was FDA approved about five years later after he had received it, but he didn't have five years to wait. He had at best a couple of months. Another example we had was a young woman, 35 years old with hormone positive breast cancer. We helped her optimize her care in many different ways, but I'll give you just one example, which is we did tumor sequencing, and it showed that she had a fusion subclone known to be resistant to hormone therapy.
(45:24):
This patient had hormone positive cancer, so she needed to be on hormone therapy for five to 10 years. Here we get these results that show that standard of care hormone therapy, it's not going to cut it. It turns out there was some early data at the time that showed a class of drugs called CDK4/6 inhibitors reduced the risk of recurrence in similar patients, and we were able to put her on that regimen and avoid a therapy that would've been completely ineffective, would've just given her side effects, and from which her cancer may have recurred due to it being ineffective. The ability to avoid a potentially late stage cancer occurrence is tremendous for the patients because we know that early stage cancers are much, much more survivable than late stage cancers, but also really impactful to the plan because a stage four cancer is about four times more expensive than a stage one.
Lee Hafner (46:22):
Thank you. The human stories I think are the most impactful and these benefits are incredible, but they're not complete without the communication around them. So I do want to get to some questions, which actually includes a little bit of that with the time that we have left. Quickly though, Stephanie, what PBM do you use?
Stephanie Porrino (46:47):
We use a PBM called VerusRx.
Lee Hafner (46:52):
Thank you. And Chris, what EAP do you use?
Christopher Smith (46:56):
We use an EAP called Journey.
Lee Hafner (46:59):
Okay. One quick question, Chris, too, for waving the mental health copay, confirming that this was not in an HDHP as I don't think that can be done, so just wanted to double check on that.
Christopher Smith (47:18):
Yeah. In an HDHP, it's funny, that's a great question because funny enough, we are rolling out an HDHP for the first time come January. So Stephanie, I'll definitely be talking to you all. I have some questions, more questions, I'm sure. But we wanted to do everything that we could to keep this rich. And obviously with an HDHP, there's a little bit more rigor in how you can price things. But I will say that in the spirit of wanting to minimize any cost burden on the mental health front, once the deductible is met on mental health outpatient visits, co-insurance is waived. So that's our way of trying to parallel the spirit of no cost.
Lee Hafner (48:17):
Perfect. Thank you. Stephanie, you had a lot of love about that onsite clinic story that you've told. I think one of the questions though is, this is amazing, but for folks who have, they're managing multiple locations, do you have any other thoughts about ways to give people quicker and more convenient access to care if they can't bring an onsite clinic directly to folks at the workplace itself?
Stephanie Porrino (48:46):
Well, I have a couple of thoughts, but the company that we are working with can provide multiple units depending on the size of the organization. I know that they've worked with other companies with multiple locations, but my other thoughts is that you can actually do a contract with a local provider's office. They call it the DPC, the direct primary care. We're doing the same thing, but ours is onsite. So for those employers that are in a remote area or just any area, find a really strong direct primary care group and talk with your insurance company and see if they can get you to coordinate rates, and then you have predictability and availability. Our issue was, because we started down that road, we were going to look for a DPC local to our shipyard, but knowing the habits and the low utilization, it wasn't practical. That's why we made the decision to bring them on site.
Lee Hafner (49:51):
We are right up against time, but Chris, I want to just get one more quick question into you, which is having a robust communication strategy around everything from Color Health to the mental wellness to anything and everything you offer benefits-wise, do you have two or three very specific ways you communicate with your workforce that you find to be very impactful to get people engaged?
Christopher Smith (50:17):
I think Stephanie has the answer to that. That's the free PTO raffle. That's the thing. That's how you get people engaged. No, and by the way, I love that initiative, Steph. I think that's very creative. I'll make this short. Again, in the spirit of making things easy, I think most of us benefits people, HR leaders, lots of us are prideful in the fact that we have so many great offerings, such great benefits that arguably a lot of folks may not be able to get on their own and we've got it. But I think what bedevils us all the time is that people don't know about it. How do you get to these things when you need it? Yeah, we send a campaign and email at least once a year during open enrollment, but the situation that you're facing is now long past open enrollment. How do I get to this?
(51:06):
Make it easy. We've invested in, and it's been up and running for a little while now, a benefits website that is both internal and external facing. That was purposeful for me because I think that usually, Lee, the benefits experience does not happen between 9:00 and 5:00 usually. At least for me, it tends to happen once I've picked up my daughters or once I'm at the pharmacy or it's eight o'clock at night and I'm trying to figure out what doctor to call for what. I know it's a little hard for me to have to remember my VPN login to go into the internet and tether to that to then dig through my way to information about my benefits. Let's make it easy. We've gotten a lot of kudos on the benefits website. Partnering with our ERGs has also been very effective and/or partnering with small communities, so to speak.
(52:03):
Lunch and learns, the old school, as I like to call it, the old school conversation. I have found those to be very impactful and being able to share those stories in a real human to human way that could be a game changer for so many people and their families.
Lee Hafner (52:22):
Thank you so much. I can't thank our three panelists enough, Stephanie, Natalya and Chris for your expertise and taking the time to share that with everybody today. Thank you to all of our attendees. Please return to the homepage in order to tune into the next session, which is a fireside chat on the AI impact on the mental health crisis at work with Paula Peralta. Hope all of you have an amazing afternoon. Thank you.