At the Community Oncology Alliance (COA) Payer Exchange Summit V, 2 employer groups and a provider participated on a panel to provide practical insight into the extraordinary challenges and decisions that employers and employees with a cancer diagnosis are faced with.
Published Online: December 19, 2016
Surabhi Dangi-Garimella, PhD
WITH DISCUSSIONS AROUND CANCER CARE QUALITY AND cost, payers—either health plans or employers—are concerned with what it means for them and for their patients. At the Payer Exchange Summit V, sponsored by the Community Oncology Alliance (COA), held October 24-25, 2016, in Tyson’s Corner, Virginia, 2 employer groups and a provider participated on a panel to provide practical insight into the extraordinary challenges and decisions that employers and employees with a cancer diagnosis are faced with. Panel participants included Alice McAbee, CEBS, CCP, SPHR, SHRM-SCP, DynCorp International; Marianne Fazen, PhD, Texas Business Group on Health; and Barry Russo, The Center for Cancer & Blood Disorders.
“Cancer is a top condition that concerns employers, because of cost, the quality of care, and the complexity associated with managing the disease,” Fazen said. “Employers are interested in helping their employees. With our coalition, we want to talk about the entire journey for the employee patient and also for employers to have access to the patient information.” Fazen then shared a video of a stage production on the entire cancer journey, which she said helped make a very significant impact in getting the message across to their employees.
According to Fazen, the top 3 challenges for employees are cost, the quality of care, and supporting employees who have cancer as they try to return to work and a sense of normalcy. “The employer needs to accommodate them at the workplace, providing options such as rest time, changing their job profile to avoid heavy lifting, etc.”
Representing a care provider organization, Russo presented another aspect of cancer care: the delivery of care itself. “One of several challenges is the complexity of the delivery system. Because we have so many sub-networks, keeping patients informed is a difficult task,” he said. According to Russo, the preauthorization process adds a significant challenge to care delivery. “Having the patient wait 7 to 14 days to initiate therapy, as we try to go through the hoops, is difficult for us, in addition to what the patient endures as they wait. Meeting an ideal timeframe is a significant challenge,” he said. “Our third challenge is getting connected to the employers to explain to them what the [Quality Oncology Practice Initiative] certification means, along with other aspects of care. So, the coalition has provided us a great opportunity for this.”
“For us, curbing our healthcare costs impacts whether someone has a job next year,” McAbee told the attendees. “So, while cost is important, we are struggling with whether our employee has the right care at the right time.” She added that even if the employee does not raise this concern, having an advocacy model at play ensures that employees and their families have adequate care.
Fazen is a firm believer in the potential of education programs to align the different issues faced by employees. “For example, during one such program on precision medicine, one on the benefit managers in attendance said that if this is so valuable, ‘How come my benefit plan does not offer precision medicine?’ It turned out that they did offer employees the option of genetic testing, but the information was provided only if the employee asked about it. So, that is a care gap … a communication gap,” Fazen said.
Russo said, “We need to listen to what employers are looking for and what their needs are. We can also help employers create a checklist of things that employees might need once they are diagnosed with cancer.” “Too often it’s easy for those in my role to lose sight of what patients and providers are looking for,” McAbee said. “So, the answer is in the individual patient experience and being mindful of what they need.” Fazen agreed and emphasized the important support of a nurse navigator for the process. “Having a nurse navigator at the workplace, who is a patient advocate and a navigator, can have a significant impact, as can a convenient site for drug administration,” she said. “Working with the coalition helps cross-educate providers, payers, and employees on what options are available for the employee patients.”
“We have to start trusting each other for a better outcome for the patient and a better outcome for the process of better outcome,” according to Russo. “And benefit literacy is extremely important for this. The continuous learning process is ultimately going to deliver a better product to the patient. Ultimately, we will be at risk as a provider, but we have to understand the pieces to deliver better on the care we provide,” he said.