Comprehensive health plan assessment offers strategies to drive better value and outcomes and reduce waste to support oncology patients
WASHINGTON – Jan. 7, 2019 – While cancer deaths have been declining since the early 1990s, costs have continued to increase with more than $147 billion spent for cancer care in the United States in 2017. Despite these rising costs, employers and health plans have been reticent to manage oncology care and are also faced with keeping pace with technology and treatment advances. To help purchasers drive better value and outcomes and reduce waste in cancer care, the non-profit National Alliance of Healthcare Purchaser Coalitions (National Alliance) released an assessment of how health plans are currently managing cancer for their employees and families.
The report, Achieving Value in Cancer Care, identifies gaps in treatment and related benefits administration based on the National Alliance’s annual eValue8 survey of health plans. It provides a framework and recommendations for purchasers, health plans and providers to collaborate on the delivery of high-value patient-centered care.
“Nowhere in healthcare are employers facing a greater challenge to provide quality care at a reasonable cost than in cancer treatment and support,” said Michael Thompson, president and CEO, National Alliance. “The fast pace of innovations in oncology has had a dramatic effect on employees and employers—giving rise to availability of, and demand for, health benefit-related support services that were virtually unheard of just a few years ago. Our opportunity to enhance cancer care delivery has never been greater as stakeholders collaborate toward a high value, high performing, highly responsive system of support on behalf of cancer patients and their families.”
Report findings
The results of the eValue8 deep dive report revealed that health plan performance with respect to cancer care and support varies across plans, much as it does in other areas such as behavioral health and heart disease. More importantly, the study found that even though health plans, as an industry identified cancer treatment as a critical issue, there remains an essential need for plans to review and enhance the cancer patient’s journey so that purchasers and patients have access to affordable and quality care.
Recommendations for purchasers include:
- Develop and communicate a patient-centered approach for cancer care benefits that provides comprehensive support to employees and families impacted.
- As many cancers can now be treated as a chronic disease, ensure care with an eye toward the entire patient’s journey that will include psychosocial support, benefits coordination, successful recovery, ongoing management and an effective and accommodating return to the workforce.
- Review current benefits coverage to assess against coverage needs for standards of personalized, evidence-based cancer treatment and assess how new treatments can be included with an eye to reasonable costs for care.
- Change how care is paid for to accelerate adoption of best practices; also look to bundled payment options to address quality and cost.
- Review data sources and root out waste associated with high costs and poor outcomes related to inappropriate or low-value care, poor adherence, and high cost variation by site of care.
The report was developed in collaboration with a diverse array of subject matter experts, coalition leaders, and purchasers including the National Alliance Oncology Purchaser Advisory Committee, consisting of five purchasers from across the country including: Orange Co. Public Schools, Segal Consulting, The Board of Pensions of the Presbyterian Church (U.S.A.) and Wyoming School Boards Association Insurance Trust. Six coalitions spent considerable efforts related to oncology and provided their expertise and time: Dallas-Fort Worth Business Group on Health, Florida Health Care Coalition, Greater Philadelphia Business Coalition on Health, HealthCare 21 Business Coalition, Northeast Business Group on Health and Pacific Business Group on Health. Additional support was provided by the following sponsors: Cancer Treatment Centers of America, Genentech and Merck & Co., Inc.
About National Alliance of Healthcare Purchaser Coalitions
The National Alliance of Healthcare Purchaser Coalitions is a nonprofit network of business coalitions, representing more than 12,000 purchasers and 45 million Americans, spending more than $300 billion annually on healthcare. The National Alliance is dedicated to driving innovation, health, and value along with its coalition members through the collective action of public and private purchasers. To learn more, visit nationalalliancehealth.org, connect with us on Twitter and LinkedIn.
# # #