Health care navigation's vital role in cancer care
Benefits advisors and self-insured employers seeking to offer access to the most advanced care and support must weigh several key considerations as they evaluate health care and benefits programs for employees.
These remarkable advances, however, translate into a vastly more complex care landscape for patients and their families to navigate. With cancer now topping the list of companies’ most costly health conditions, benefits advisors and self-insured employers seeking to offer access to the most advanced care and support must weigh several key considerations as they evaluate health care and benefits programs for employees. The right health care navigation partner should play a key role in guiding employees through this difficult journey.
Cancer care is different
Health care navigation, as an umbrella term, refers to services that help patients access and coordinate their care. As the cost and complexity of health care have increased for employers and their employees, expert personalized care navigation has gone from being a nice-to-have benefit to becoming a crucial factor for managing runaway costs and ensuring the best possible health outcomes. Nowhere is this more the case than with cancer care. Seventy years ago, medical knowledge doubled every 50 years; today it doubles every 73 days. What were once thought to be a small number of cancer types are now understood to be numerous subtypes and variants. Oncology as we know it is, in fact, multiple subspecialties defined by site of origin and DNA blueprint — each with distinct and rapidly evolving targeted therapies and treatment paths, depending on the individual and their circumstances. As cancer care becomes more personalized and specialized through advances in precision medicine, gene-based therapy, immunotherapy and other innovations, many oncologists are simply unable to keep up — nor can they be expected to in the face of such rapid change.
Consider genomic testing, which increasingly directs patients to the treatment that will be most effective for them as individuals, thus yielding better results with potentially lower long-term costs. With curable early-stage breast cancer, for example, genomic testing has been effective in identifying patients who do equally well with or without chemotherapy. The ability to defer or avoid the use of chemotherapy in such patients decreases the risk of toxicities, saves cost, and produces equivalent or superior survival outcomes. Likewise, a research trial might be the best and most cost-effective option for many cancer patients. Eight to 10 years ago, a patient with metastatic lung cancer who wasn’t in a clinical trial likely would have died from the disease within months, whereas that same patient could still be alive today if they had been enrolled in a trial and received the experimental medication that is now the foundation of today’s standard therapy.
As our knowledge of cancer advances at such an accelerated pace, there is a widening nationwide expertise gap that is driving over-, under- and misutilization of care. Health plans and delivery systems are unable to keep up with ever-evolving cancer guidelines and need support to ensure that all patients have consistent access to the most current data and best treatments. Narrow networks that work for other conditions where expertise is widespread serve as artificial barriers to access when it comes to cancer, making it far less likely that a member will be able to receive the specialized care their cancer demands. In all these ways, cancer care is different. And programs that put oncologists at financial risk for cost outcomes they cannot control are turning oncology practices into insurance companies. Employers looking to ensure the most optimal outcomes for their employees must recognize these issues and seek health care navigation solutions designed to keep pace with the field’s rapidly changing demands and focus on value through the employee’s eyes.
Rapid interception and direction to specialized expertise are critical.
Speed matters in all aspects of cancer care, and patients deserve access to the level of expertise and subspecialized support that optimizes chances of survival. Failure to get the right care begins with misdiagnosis, which leads to patients not getting the level of expert review they should. Lack of access to the right diagnosis and the right care early on can result in worse outcomes for the patient and much higher (and unnecessary) costs for employers. This is particularly true when the opportunity to potentially cure a patient is lost because the patient received a less effective, lower value treatment up front. The cost of treating relapsed, refractory and metastatic cancers, for example, can far exceed the cost of delivering the best and most-effective care from the beginning.
Employers and their advisors should look for navigation solutions designed to identify and intercept the cancer patient early on and, where merited, mobilize advanced cancer knowledge to reach those who need it most.
To be their most productive selves, employees with cancer need wraparound support.
Whether they are the patient or a caregiver, few diseases can threaten an employee’s sense of wellbeing more than cancer. Although the vast majority of employees who receive a cancer diagnosis want or need to keep working throughout treatment, the challenges of doing so can be insurmountable. Employers that are already seeing 12% of their total health spend go to cancer care must factor in the indirect costs associated with lost productivity and work time — estimated to be $139 billion annually. By offering comprehensive wraparound care coordination support during this difficult time, employers are both doing what’s right for their employees and what’s best for their business.
What does this look like? A care coordinator becomes the patient’s personal guide to accessing a broad range of resources and expertise. Clinicians are fully embedded in the patient’s team, advising them on what to expect from side effects and helping them understand their benefits in the context of recommended treatments, among other things. Wraparound support also means anticipating and addressing the surrounding repercussions of a cancer diagnosis and treatment. One in four people with cancer will develop clinically significant depression — a rate 2 to 3 times that of the general population — which can affect their ability to work and function on a daily basis. Cancer care navigation should help identify such issues early and guide members to the help they need, whether it’s behavioral health services, nutrition counseling or access to social services.
The science-fiction writer William Gibson is famously credited with the following statement: “The future is already here. It’s just not evenly distributed yet.” In this time of awe-inspiring advances in cancer treatment, our greatest challenge may indeed be one of distribution: How do we efficiently and equitably make these extraordinary advances accessible to everyone? The pandemic has only increased the urgency of closing the widening gap separating optimal care from usual care, with years of delayed screenings now fueling a surge in advanced cancer cases — a surge that could see cancer consuming employers’ health spend by 2025. In this high-stakes scenario, employers and their advisors can no longer afford to get by with limited one-size-fits-all care navigation. They need solutions designed for cancer care that can help close the widening expertise gap and get their employees the care they need, when and where they need it.
Harlan Levine, MD, is Clinical Advisory Board Chair, Quantum Health, and Chair of the Board of Managers, AccessHope.