- Employers and payers should ensure their health plans use patient-centered methods and provider performance measurement strategies to reduce costs and improve cancer care, a report from the National Alliance of Healthcare Purchaser Coalitions stated.
The cancer mortality rate has dropped 25 percent since the 1990s, the report states, but costs of treatment have only increased. Average care costs of some common cancers now range from $100,000 to $300,000, the Alliance said.
The rise in spending has raised concerns for employers responsible for providing benefits and coverage that enable access to high quality 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.”
Health plans will need to reassess the beneficiary journey from diagnosis to outcome, the report asserts.
“One of the key concerns is ensuring that newly-diagnosed members with cancer have the support they need to achieve timely access to quality and appropriate care,” National Alliance said in the report.
“Our research revealed that health plans are at the early stages of sorting out the most effective navigation and delivery platforms for providing patients the support they need to make informed choices about their cancer care.”
While some plans are offering diverse patient support services, including clinical and psychosocial services, only two plans assessed by National Alliance offer a treatment option decision support tool specifically for cancer care.
Moreover, most plans do not offer face-to-face services designed to replace “informed patient consent” with “informed patient decisions,” a key component of fostering a patient-centered, collaborative care environment.
The organization advised purchasers to insist that plans improve and demonstrate broad use of treatment option decision support tools and shared decision-making resources.
Additionally, National Alliance recommended that purchasers ask plans to assess and improve on member specificity and cost estimate features of shared decision-making and treatment option support tools.
The organization also evaluated health plans’ adoption of cancer patient-centered medical homes (PCMHs), which encourage practices to organize care around patients with cancer, work in teams, and track care over time.
National Alliance found that health plans vary in their adoption of cancer PCMHs, with those that offer PCMH ranging widely in standards required and type of support offered to providers.
National Alliance recommended that employers go further than asking plans about the accessibility of cancer PCMHs.
“Probe beyond availability of cancer PCMHs—ask for details of plan standards, required services and plan-provided resources for their cancer PCMHs,” National Alliance advised.
In addition to assessing patient-centered approaches in health plans, the organization evaluated health plans’ criteria for selecting cancer care providers.
The report found that when it comes to selecting cancer care providers, health plans rarely examine criteria beyond board certification. Only one health plan assessed by National Alliance considered criteria in oncology specialty or subspecialty, and just one of five plans has separate accreditation for hospital-based radiation therapy.
The report suggested that employers ask plans about the standards they use when choosing cancer care providers.
“Ask your plan about any specific criteria beyond credentialing and Board Certification they use for selecting their oncology networks and radiation facilities or providers,” National Alliance said. “Ask if they consider patient safety data, e.g., chemotherapy and/or radiation overdose.”
The report also found that there is a gap in health plan cancer care measurement activities, with provider performance measurement lacking even in cancer PCMHs and accountable care organizations (ACOs). Measuring cancer care quality and provider performance could ensure patients are receiving the best care possible and could help payers and plans track patient outcomes.
National Alliance advised payers and employers to push for quality performance metrics in their health plans.
“Insist that your plans implement, within a year, one or more Core Quality Measures,” the report said. “Ask your plan to provide you with a timeline or plan of action for Core Quality Measure implementation, feedback reporting and inclusion in payment models.”
With these recommendations, healthcare purchasers and plans can work toward providing quality, affordable care to cancer patients.
“Our opportunity to enhance the value of cancer care has never been greater as employers, health plans and providers collaborate toward high value, high performing, highly responsive system of support on behalf of cancer patients and their families,” the report concluded.
“It is incumbent upon employers to be a force for positive change by working with their health plans and PBMs to drive implementation of best practices, increased value and improved outcomes in cancer care.”