In today’s healthcare landscape, the focus is shifting toward addressing the rising costs associated with cancer. The word 'cancer' itself, historically attributed to Hippocrates, who used the term to describe non-healing ulcers and masses,1 has now burgeoned into a complex medical challenge. It's not merely a single disease but an umbrella term for an array of conditions characterized by uncontrolled growth and spread of abnormal cells.
Today, cancer continues to be a leading driver of healthcare expenditures, outstripping musculoskeletal and cardiovascular conditions by accounting for 12% of health care spend—a figure that's expected to rise even more.2 The oncology landscape is rapidly transforming, with an increasing number of cancer subtypes recognized through next-generation genome sequencing, adoptive immunotherapy, gene therapy, and precision medicine. These advances are revolutionizing cancer care at an unprecedented pace, with medical knowledge in the field now doubling every 73 days.3
Despite these advancements, the gap between optimal and standard care is widening, exacerbated by geography and the sheer speed of innovation. Community oncologists, who are responsible for 80% of cancer care and may see an average of 20 patients per day, are particularly challenged. They confront a vast spectrum of cancer types, with the need to stay abreast of the latest treatments for each unique case. The critical question then arises: How can we bridge this gap in cancer care knowledge and leverage the latest research and innovations from Centers of Excellence (COE), traditionally the go-to for specialized cancer expertise?
How is This Different From Centers of Excellence (COE) programs?
Centers of Excellence set the benchmark for specialized care, offering multidisciplinary expertise and high-quality treatment for complex conditions like cancer. However, the rapid evolution in cancer treatment—marked by personalized medicine and technological advancements—calls for a more dynamic and accessible approach. Given the geographical and access limitations that prevent individuals from traveling to one of these centers, modern cancer benefit programs must pivot towards more inclusive, comprehensive care and support that addresses the nuances of a diverse and geographically dispersed workforce. The focus now is changing the way leading-edge cancer expertise is delivered so that it is integrated, personalized, and adaptive to the fast-paced changes in oncology care.
In this context, public employers and organizations, labor funds, and fund administrators face a pivotal challenge: providing expert cancer support to a subset of their members affected by cancer, which constitutes a relatively small proportion of the workforce, while managing health care costs and reducing wasteful spend to advance value-based care.
8 Key Considerations for Fund Administrators to Evaluate Cancer Support Programs
#1: Addressing the Needs of a Diverse Population
The foremost consideration in evaluating cancer support programs is the ability to effectively serve a demographically diverse population. Public entities are rooted in defined geographies—each with its unique health profile shaped by local demographics, social behaviors, and environmental factors. A nuanced approach is necessary, one that incorporates Diversity, Equity, and Inclusion (DEI) to ensure access to expert care and support for all community members.
To truly know and serve your population, it is essential to delve into the specifics of health status, influencing factors, and the community's needs, with a keen eye on data at the county level. This methodology is supported by research, such as the study published in JAMA Network Open, which illustrates the complex relationship between health outcomes and local conditions. The study found a consistent link between obesity and breast cancer mortality across 2,176 US counties, yet the impact of access to healthy lifestyle resources varied significantly by location.4 This indicates that interventions must be customized: what works in one county may not in another, and recognizing these differences is key to reducing health disparities and improving outcomes.
Incorporating these insights, cancer support programs can be designed to meet the specific needs of a community, acknowledging that the built environment and social determinants of health are just as critical as medical care in combating cancer incidence and mortality.
#2: Breaking Down Access Barriers
For public sector and labor fund administrators tasked with evaluating cancer support programs, ensuring seamless access is crucial. Access barriers can range from financial hurdles to logistical constraints, each one potentially delaying critical care for patients in need.
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.
As we prepare for a future where the number of cancer survivors is expected to reach 26 million by 2040, with a majority being of working age,5 the necessity for adaptable support programs becomes clear. These programs must be able to meet the diverse and changing needs of survivors throughout their journey. This foresight is echoed by the trend observed in the WTW 2022 Best Practices in Healthcare Survey, which notes that 50% of large employers are considering or have already implemented services offering cancer second opinions.6 Emulating this proactive strategy in the public sector will be crucial in providing a robust support system for the growing survivor population.
#3: Evaluating Expertise and Support
In the context of public sector organizations, where the scope of impact and the nature of accountability may differ from the private sector, the evaluation of cancer support programs necessitates a discerning look at the expertise on offer. This evaluation must probe beyond basic research to consider the depth of expertise that can profoundly affect the quality of care for their members, which may include public employees, retirees, or beneficiaries of public funds.
Seek information about the composition and qualifications of the medical review team—whether it’s a comprehensive team of multidisciplinary experts or a single individual. Understanding the range of expertise, from general oncologists to subspecialists, is significant, particularly given the complexity of cancer care. There are currently more than 100 different types of cancer, with emerging variants that require unique treatment paths.
The level of support when delivering and discussing treatment plan recommendations is also pivotal, particularly in a public sector context where clarity and transparency are paramount. Assess whether members are burdened with interpreting medical terminology and complex treatment plans on their own, or if there's a streamlined, direct dialogue between the treating oncologist and the reviewing subspecialist. This communication is critical for effective clinical decision support and for providing advocacy that empowers members and their families to make well-informed healthcare decisions. Such considerations ensure that the program aligns with the public sector's commitment to serving its community's health needs responsibly and effectively.
#4: Leveraging Data to Optimize Treatment Plans and Reduce Costs
An effective cancer support program utilizes data analytics to proactively identify members who could benefit from timely expert interventions which, in turn, may help improve outcomes and reduce wasteful spend on unnecessary treatments. Notably, just 5% of adults in employer-sponsored health plans account for 52% of healthcare costs, while the bottom 50% account for only 3% of the total costs.7 By targeting interventions towards the smaller group that generates higher costs, significant savings can be achieved without compromising care quality.
Advanced algorithms that analyze claims data can pinpoint complex and high-cost cases, especially in cancer care, guiding early interventions that may reduce toxicity, side effects, and long-term complications from unnecessary therapies. Considering that a third of U.S. medical spending is tied to complex care conditions, with cancer being a primary factor,8 and that 84% of individuals with a cancer diagnosis do not seek a second opinion,9 the potential for improving care and reducing costs through data-driven decision-making is immense.
#5: Integrating Seamlessly in Benefits Ecosystem
When providing cancer support, how well it integrates into the organization’s existing benefits ecosystem will directly impact its reach and effectiveness.
The member experience across the landscape of healthcare vendors should be seamless. In other words, when an employee reaches out for cancer-specific support, they should be promptly and effectively connected to the right service provider.
Prompt and effective connections to the right resources and programs can foster a positive relationship and experience for the member, reinforcing the importance of a well-integrated support system within the public sector's healthcare framework.
#6: 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.
#7: 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?”10
#8: Choosing the Right Channel
Selecting the appropriate channel to acquire cancer support services involves both financial and administrative considerations. Factors like pricing advantages and contracting responsibilities weigh heavily on decision-making.
The organization’s size is another factor to consider. Larger public entities 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.
AccessHope: Redefining Comprehensive Cancer Support
In the intricate web of public sector benefits solutions, AccessHope emerges as a comprehensive cancer support solution tailored to the unique requirements of public employers and labor funds.
Bridging Expertise for Better Outcomes
AccessHope connects public sector employees and beneficiaries directly with NCI expertise, without disrupting the essential physician-patient relationship. In more than 90% of cases, AccessHope offers evidence-based recommendations to improve cancer management.11 Additionally, our experts identify relevant clinical trials in 43% of cases reviewed, demonstrating a commitment to enhancing cancer support with the highest regard for existing care relationships.
Accessible Excellence
The value of expertise on leading-edge treatments and breakthrough discoveries in cancer care is immeasurable, and AccessHope respects the existing physician-patient relationship by offering remote case reviews for all cancer types. This innovative service enables members to maintain their relationship with their local treating physicians while benefiting from the expertise of top oncology specialists from NCI centers. For individuals who aren’t able to travel to a Centers of Excellence for a comprehensive evaluation, AccessHope brings the acumen of foremost medical centers directly to members and their treating oncologists, irrespective of their location.
This comprehensive approach extends to complex cancers through AccessHope’s Accountable Precision Oncology 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.
By facilitating such direct access to specialized knowledge, AccessHope is not just a service but an integral part of the care continuum, offering public sector members a level of support that traditionally would have been out of reach without significant travel and expense.
AccessHope's Exceptional Impact
AccessHope offers a valuable service with easy access to support resources. This is further validated in a peer-reviewed study published in the Journal of Clinical Oncology12, 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. AccessHope’s suite of services transforms expert cancer support and prioritizes the employee experience, evident in an impressive Net Promoter Score (NPS) of 89, far exceeding the industry average of 5-15.
For public employers and labor funds, adopting AccessHope means enhancing cancer support while preserving the sanctity of the physician-patient relationship and delivering the expertise of major centers directly to where it's most needed. This is how AccessHope reshapes benefits to meet the distinctive needs of the public sector workforce and its dependents.
