In today’s healthcare landscape, the focus is shifting towards addressing the rising costs associated with cancer. For organizations and health plans managing expenses, cancer has become a significant contributor to healthcare spending.
When self-insured organizations aim to provide expert cancer support to their members, they face a unique challenge: while cancer tops the list of high-cost insurance claims1, those with a cancer diagnosis represent only a portion of the workforce. So, what’s the most effective approach to meet the diverse needs of individuals dealing with cancer while keeping healthcare benefits affordable?
7 Key Considerations to Evaluate Cancer Support Programs
#1: Evaluating Expertise
When evaluating cancer support programs, it’s essential to consider the depth of expertise they offer. This goes beyond surface-level research and should instead look at the details that can make all the difference for an employee. This means understanding the level of cancer expertise and support available. Is the case reviewed by a multidisciplinary team of experts or an individual? Is the reviewing physician a general oncologist or subspecialist? Are they currently practicing or retired?
How recommendations are communicated is also important and can impact the development of treatment paths. Are members expected to decipher medical jargon and negotiate complicated treatment options? Or is there direct physician-to-physician dialogue between the member’s treating oncologist and reviewing subspecialist for clinical decision support? Does the process provide better advocacy support for members and their families to make informed healthcare decisions?
#2: Breaking Down Barriers
When it comes to cancer support, access isn’t just a convenience; it’s a lifeline. Self-insured employers should consider solutions that operate outside the traditional medical plan design where potential barriers are not a limiting factor for anyone needing specialized expertise and support.
Large deductibles and coinsurance
Large deductibles and coinsurance arrangements can deter individuals from seeking necessary support, affecting their overall care experience.
Required referrals
Seeking treatment or a second opinion becomes more complicated when referrals are required. For cancer patients, referrals can sometimes cause delays in diagnosis and treatment.
travel
Travel requirements for treatment or expertise can pose challenges for patients, especially those who are immunocompromised, potentially affecting timely and consistent care.
Conditional support
While some cancer support programs only offer assistance at certain stages of the journey, the entire span from the time of diagnosis or pre-diagnosis through the course of the illness is both clinically intensive and emotion-laden. Therefore, support should cover the full spectrum of cancer-related needs.
Given the projected increase of cancer survivors in the U.S to be 26 million in 2040, with 67% considered to be working age (under 65 years old)2, it is important to find a program partner capable of addressing their unique needs throughout this journey.
#3: Enhancing Care and Reducing Costs
An effective cancer support program proactively identifies members who can benefit from timely expert interventions while controlling costs.
To illustrate this idea, 5% of adults in employer-sponsored health plans represent 52% of costs. And on the other hand, the bottom 50% of the population accounts for only 3% of total medical costs.3 This showcases the importance of implementing programs that can target members who are likely to have high costs, for which interventions may help reduce.
Data analysis is key
Algorithms leveraging claims data (whether through a health plan, third-party administrator, or even the pharmacy) can help identify complex and high-cost cases, especially in cancer.
When it comes to healthcare costs, a third of medical spending in the U.S. is associated with complex care conditions, cancer being the leading driver.4 Because a patient’s outcomes can vary significantly from case to case, early expert intervention can guide patients and their oncologists toward the right treatment paths, potentially reducing avoidable and wasteful expenses on unnecessary tests and treatments.
misdiagnosis can be prevented
Misdiagnosis is also a critical issue when it comes to receiving the best treatment plan. Alarmingly, 84% of people who’ve received a cancer diagnosis don’t seek a second opinion.5 The reluctance to seek a second opinion might stem from a variety of factors, from fear and urgency to simply being unaware of the impact it may have on their care journey. Regardless, encouraging individuals to seek second opinions can prevent misdiagnosis and lead to well-informed decisions about their care.
#4: Fostering a Holistic Ecosystem
When providing cancer support, how well it integrates into the organization’s existing benefits ecosystem will directly impact its reach and effectiveness.
How does the member experience progress across the landscape of healthcare vendors? In other words, when an employee reaches out for cancer-specific support, are they promptly and effectively connected to the right service provider?
Ensuring that members are promptly connected to the right resource and program establishes a more positive relationship and experience. Empowering individuals with a clear understanding of their benefits is equally important.
#5: Review Unbiased Studies
Analyzing a program’s clinical and financial impact requires careful consideration of various types of evidence.
Many programs claim that they lower medical costs and improve outcomes, yet they have not been validated by studies which can be complex and challenging to perform.
The next best evidence would be observational studies to answer questions like: “Did the program help lower costs?” Or, “Is the group in this study similar to members in our workforce?”6
#6: Choosing the Right Channel
Choosing the right channel to purchase a cancer support service involves careful consideration of financial benefits and administrative simplicity. Factors like pricing advantages and contracting responsibilities weigh heavily on decision-making.
The organization’s size is another factor to consider. Larger organizations may prefer channels that match their scale and capabilities, while smaller ones might opt for alternatives tailored to their specific needs. Finding the right balance between cost-effectiveness and ease of contracting and implementation ensures the chosen channel maximizes the program’s benefits.
#7: Measuring Employee Satisfaction
Assessing the member experience, often facilitated through surveys, can reveal the true impact and success of a cancer support program. Member engagement and satisfaction contribute to better outcomes, higher morale, and a culture of care and collaboration.
AccessHope: Redefining Comprehensive Cancer Support
In today’s complex landscape of benefit solutions, AccessHope stands out as a comprehensive cancer support provider aligned with the needs of self-insured organizations.
Bridging Expertise for Better Outcomes
By connecting individuals and their treating oncologists with expertise from NCI centers, AccessHope can help ensure the member is on the optimal treatment path through expert reviews. In more than 90% of cases, AccessHope offers evidence-based recommendations to improve cancer management.7 Additionally, our experts identify clinical trials in 43% of cases reviewed.
Accessible Excellence
As stated above, accessing expertise is vital for cancer support. AccessHope makes it easy by eliminating the need for long trips or changing doctors through remote case reviews. Plus, the benefit operates separately from regular medical plans, eliminating financial barriers like high deductibles and coinsurance, ensuring access to timely expert knowledge.
This comprehensive approach extends to complex cancers through AccessHope’s Accountable Precision Oncology8 program, which proactively identifies cases that are the most complex, or the most vulnerable to care mismatches in the treatment plan. It automatically initiates an NCI expert case review without requiring members to opt in.
AccessHope's Exceptional Impact
AccessHope offers a seamless experience with easy access to support services. This is further validated in a peer-reviewed study published in the Journal of Clinical Oncology, which reinforces AccessHope’s remote model of expert case reviews. Recently, a new study published in Journal of Personalized Medicine affirms cancer subspecialist reviews helped identify care gaps to improve treatment paths for patients with pancreatic cancer. Both studies showed AccessHope oncology subspecialists provided evidence-based recommendations in over 90% of cases reviewed to help optimize treatment paths and health outcomes.
Furthermore, AccessHope’s versatility is shown as it expands across various channels, serving direct employers, health plans, partners, and TPAs. This dynamic approach transforms cancer support and prioritizes the employee experience, evident in an impressive Net Promoter Score (NPS) of 90, far exceeding the industry average of 5-15.
By embracing AccessHope, self-insured employers can improve cancer support and reshape their benefits to better suit their workforce’s unique needs.
