Value-Based Oncology Care Solutions for Self-Insured Employers

Cancer care and treatment advances have led to significantly improved patient outcomes. In the United States, the cancer death rate fell by 25% from 1990 to 2014. However, the costs of these advances are significant, as the NIH reports that a 4-year cancer treatment program can range from $101,000 for breast cancer to as much as $282,00 for lung cancer. Employers must navigate how to best manage the new landscape of evolving treatments and pathways while balancing them with increased costs.

In “Engagement of the Self-Insured Employer Community Seeking Precision and Value—Challenges and Potential Solutions,” presented at the 2022 Oncology Clinical Pathways Congress, Margaret Rehayem, Vice President of the National Alliance of Healthcare Purchaser Coalitions, spoke on the dramatic effect that developments in cancer care have had on employers and employees.

Among major concerns for health care purchasers are that the newly diagnosed have timely access to appropriate care, cancer care advances that add a financial burden, and balancing that care while keeping watch on the rising costs.

Opportunities in cancer care include the treatment of cancers as a chronic disease, with a look ahead to recovery and management, as well as an effective return to the workforce. There is also a need to adapt more quickly to the evolving environment.

That’s where the National Alliance of Healthcare Purchaser Coalitions (NAHPC) comes into play.

“We bring together about 45 regional coalitions across the country that they themselves have about 12,000 purchasers collectively spending about $300 million in health care,” Rehayem said. “Our organization works on a variety of initiatives across the country on those regional coalitions, but we mainly focus on these three areas: delivery of care and payment reform, total person health, and health policy, with the intention of really strategizing with coalitions with their groups regionally … how they can take a look at their own approaches to their health and well-being benefits. And what can they do to shift into a more value-based care environment.”

Rehayem discussed a project that the NAHPC undertook with a number of its regional coalitions and employers.

“Oncology of itself is really growing for employers in a way that is not just paying for oncology services and programs,” she said. “It’s now starting to take a look deeper at what is happening with the total cost of care. For many employers, that is another black box they need to dive into.”

As a result of the project, the NAHPC developed an overview of the patient journey so employers could determine if they offered benefits that aligned with the patient needs.

“There is this need for employers to have a faster adoption around the environment that’s happening,” Rehayem added. “Many have benefit approaches that are 2 decades old. They need to open those up and really take a look at them.”

With the creation of the patient journey overview, NAHPC was able to develop the 2021-22 Oncology Employee Learning Modules. These divide the oncology curriculum into three parts: Prevention and Pre-Diagnosis (Module 1); Diagnosis, Treatment Planning, and Care (Module 2), and Survivorship, Surveillance, and Back to Work (Module 3).

“We put together an evaluation process where we assessed where employers were at across the patient journey and developed these learning modules,” Rehayem said. “We put together these three modules with the intention that … employers can take a step back and really assess where they’re at.”

The employer checklist for Module 1 includes entries for Screening Rates, Screening on Inherited (Genetic) Risk, and Site of Care.

The Module 2 checklist is comprised of Care Coordination and Psychosocial Support; Cancer Care Networks, Centers of Excellence, Treatment Plans; Testing for Biomarkers; and Palliative Care, Financial, and Advance Care Planning.

Module 3 includes Advanced Care Planning, Palliative Care, and Hospice; and Survivorship, Surveillance, and Return to Work.

Additionally, the impact of COVID-19 on the employer checklist has been significant. Employers must identify how COVID has affected access to care in terms of screenings and regular care, virtual vs in-person care, and coverage policies for virtual sessions.

Rehayem concluded her presentation by stating that cancer care developments have had a huge effect on both employees and employers. Unless these are coordinated and comprehensive, the evolving landscape of treatment offerings may lead to delayed or incomplete care, especially when the clinical and mortality data necessary for assessing cancer care value are not always readily available.

“When we take a look at all the advances in oncology over the last few years, the treatments that are out there are really helping to reduce the death rate,” she said. “What’s also happening at the same time is that survivorship and return to work is increasing for employers. What’s also happening is that all these advances in oncology care are really pulling at the cost side for employers. So, there’s this increased cost, and we are taking a look at the cost for employers across a number of kinds of cancers.”