Cancer care poses challenges for employers; Transcarent shares its vision of how it can help

Cancer remains the second leading cause of adult death in the United States after heart disease, with more than 1.75 million new cases reported in 2019 and 599,589 people dying from the disease, according to data from the Centers for Disease Control. From diagnosis to remission, cancer is a complex disease that can be difficult for people to manage.

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 difficult for self-insured employers, who pay about 85% of health care claims overall, according to a 2021 presentation by Dr. Shealynn Buck, Lockton’s chief medical officer, for the National Cancer Institute on employees and cancer care. However, the costs are not distributed evenly across the plan’s population since some members’ conditions are more complex than others, Buck noted. The disparity goes far beyond the classic 80/20 rule, she said: 8% of workers bear 80% of healthcare costs. Complaints are on the rise. The average cancer cost per high-cost claimant is $170,126, Buck noted in his presentation. But claims of $1 million or more have increased 31% since 2017, she said. Contributors include specialty drugs, which drive 18% of total health plan spending. New-to-market drugs that increase the lifespan of patients pose even more challenges. Cell and gene therapy and immunotherapies, which are among the most anticipated new drugs, can
incur costs of $1 million or more, according to data from Buck’s presentation. At the same time, companies are increasingly focusing on the quality of healthcare. In a survey of self-insured employers with 1,000 or more employees, Buck noted that 45% said they consider a healthcare strategy an integral part of their workforce strategy, compared to 27% in 2018. About a quarter said they would not wait for the traditional healthcare delivery system to change and are willing to partner with innovators and become active in driving change.

Although the cost is a challenge, it is only one aspect of treating the disease. The stress of coping with an illness that will take time for treatment and recovery and the impact on family caregivers requires a multi-faceted approach to giving patients and their families the resources they need.

Dr. Mary Kay O’Neill, Mercer’s Total Health Management practice partner, observed that a trend has been to integrate all services that affect a cancer patient and their family, from screening, testing, second opinion consultations and treatment to services such as behavioral health. Screening services are an important theme in employers’ programs because preventive care can help identify cancer at earlier stages when treatment might be more effective, or even less impactful.

“It’s a totally consuming thing to be a cancer patient,” O’Neill said. “It is increasingly understood that someone who has a family member undergoing radiation therapy may need to take a Tuesday afternoon off to drive their family member to treatment – ​​to support them in this way,” said said O’Neill. “There are growing efforts to connect people with what are often local resources that can help with transportation and other services.”

O’Neill said that the work undertaken by the National Health Business Group in collaboration with the American Cancer Society and Johns Hopkins, offers guidance for companies on how to think about cancer in the workplace.

An indirect impact of Covid-19 is that many have delayed regular cancer screenings, such as breast cancer, colon cancer and prostate cancer. Delays could have an impact on costs for the employer: A recent study of large employers by the National Business Group on Health, which focuses on large employers, showed that 68% of employers said they expected a higher prevalence of advanced cancers in their population due to delayed screenings .

An advantage for employers is that people of working age are less likely to develop cancer. Thus, at any given time, people with cancer tend to reflect a small minority of company personnel.

Although few in number, the cases can be disruptive. This drives employers to look for vendors who can provide innovative cost management solutions, among other steps, Buck said in an email response to questions.

“We are seeing employers turn to solutions provided by commercial carriers and third-party providers outside of the traditional health care system that meet the complex needs of the employer health plan population. Examples include AccessHope, CancerCAREAetna’s Transform Oncology Care, Employer Direct Healthcare,” said Buck.

Creation of Aetna and CVS Health Transforming oncology care in 2019 as a joint team of experts in their activities. The goal is to help patients with newly diagnosed cancer more easily navigate the complex terrain of services and treatments, including prevention and screening, diagnosis, treatment, survivorship and care. support.

Transparent is another company that serves the needs of employers in cancer care and other health areas. Matt Meyanathan, manager of Transcarent Solutions, Oncology Care, said the benefits most employees use every day don’t always drive awareness and use of traditional employer-sponsored cancer programs. This often leaves members who receive a life-altering cancer diagnosis scrambling to research relevant benefit programs.

“Additionally, employer-sponsored cancer programs sometimes include siled elements, such as a second opinion service or a center of excellence. Such programs don’t 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 cancer care program into the daily care solution so members know where to turn for cancer advice and resources if and when they need it. This woven approach provides Transcarent with better opportunities to improve member awareness and engagement on the benefits, including increasing cancer screening rates, which, in turn, can help providers diagnose cancer more early.

Transcarent’s oncology program covers all cancer types, but initially focuses on cancer types prevalent in 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 adopted since the start of the Covid-19 pandemic. The services offer support and advice that can take away some of the stress of a long-term illness and can make as much of a difference to the health of cancer patients and their families as the treatments themselves.

They also correspond to the evolution of employee expectations following Covid-19. They expect to be able to work remotely. And they expect strong, accessible health care benefits.

“Employees expect more comprehensive coverage with benefits that help them on their terms,” Meyanathan acknowledged. “Covid has expanded employee expectations for convenient, virtual or in-person access with a great experience.”

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