Part 1: Cheryl Larson on Balancing Employer Needs, Controlling Cancer Costs, and Future Goals

April 18, 2020
Maggie L. Shaw

In the first part of a 2-part preview interview in advance of this year’s virtual 2020 Community Oncology Conference, The American Journal of Managed Care® speaks with Cheryl Larson, president and chief executive officer of the Midwest Business Group on Health, about how she is helping employer organizations navigate their pharmacy benefits managers and manage employee expectations.

The 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), will take place virtually on April 23 and 24. In this preview interview, The American Journal of Managed Care® (AJMC®) speaks with Cheryl Larson, president and chief executive officer of the Midwest Business Group on Health (MBGH), who will be a panel member for “The Employer Perspective: Meeting Employee Needs While Controlling Cancer Care Costs.”

To register for the virtual conference, which takes place April 23rd and 24th, click here, and read the second half of this interview tomorrow.

AJMC®: Your session at COA is titled, "The Employer Perspective: Meeting Employee Needs While Controlling Cancer Care Costs." Can you please provide an overview of some of the areas that you'll be discussing during the panel?

Larson: I will preface it by stating that in our world, employers are the real payers of health care. It's not the PBMs [pharmacy benefit managers]. It's not the health plans or the carriers. We are the ones that are providing coverage for about 56% of all people that have benefits in the United States. That is more than the government. So, it's very important to us that we ensure that high-quality, safe, and effective care is provided to employees and their families and also that care is affordable.

I'll be discussing at the conference how many of our partners in health care have taken advantage of employers throughout the years by having wasteful practices, misuse, and low-value care increasing their costs each year. And every year, the employer costs keep going up and going up and going up, and we keep paying and paying. And little is done to address these costs because the other key stakeholders don't want to make less money. But for businesses, it's not sustainable for us.

And then finally, I'll be covering some of the challenges that employers face in managing cancer and oncology drugs, especially as it relates to genomic testing. And they [employers] don't know what they should do... Not only do they not understand that whole arena, they're not clinicians, they don't know what tests to cover and which tests not to cover. They're not getting support from a lot of their partners in figuring that out.

Just to give you a little background on MBGH: we represent mid, large, and jumbo employers. Many of the large and jumbo are getting their needs met. But it's the small to midsize employer that's paying way more for healthcare, and they have no leverage to do anything about the costs. They're bound by whatever is made available to them. And we're really doing a lot for that size employer. We're also taking advantage of all the best practices and benchmarks from the more progressive larger employers to support the needs of those smaller ones.

AJMC®: Why do you believe people should register for COA this year now that it's gone virtual?

Larson: First, I love that we're continuing to have it. Some of my sister coalitions and myself have all had to reschedule our events to later this year; a handful have gone virtual. And I know that COA has some unprecedented numbers of people participating. And every time I'm at this program, I'm impressed that they are reaching all different kinds of stakeholders. And that includes some of my fellow coalitions and employers.

There is also a great collaboration among the people attending, and we are learning from each other. You could just have a group of oncologists in the room, but you have those oncologists learning about what employers are doing or what other activities are taking place in the marketplace. You have to have a full picture to understand what role you play. So I appreciate that.

They're also bringing leading practices to the table. And they're not afraid to say things the way they are. They say it like I say it. That's what we do at MBGH educational programs and in our employer direct research projects—when we talk about waste and misuse in the system—and I appreciate that. We get a lot of people sometimes that have their mouth open because they can't believe that they just learned something they didn't know, that is kind of kept quiet or a secret off to the side. Or they're shocked that we've talked about it, and they embrace it. I love that about this program as well.

AJMC®: What do you see as the top oncology issues in light of the current COVID-19 atmosphere?

Larson: Like many of us, I'm very concerned about people that have cancer that are not getting needed treatments because the delivery system is overwhelmed with managing COVID patients. And these folks are immune-compromised with serious disease. So I don't know where they're being sent or if they're getting care at home, even though we've been dealing with this for over a month.

I don't know how benefit plan designs have changed, and I'm hoping the conference will share some of that with us. I don't know if oncology doctors are considered essential. I certainly hope so. I certainly hope that they can safely have people come in and get their treatments. But I think from a COVID perspective, there's a problem with people getting access to oncology drugs, but certainly I am concerned about these patients not getting needed treatment.

AJMC®: As president and CEO of Midwest, what do you hope to accomplish in the short term and the long term?

Larson: Great question. And I'll qualify by saying that 2020 is our 40th year in existence. And I would love to say that the industry has changed a lot. And it has, but healthcare costs continue to be out of control. So our goals related to that have not changed. Our goals are to bring leading best practices to our employer members, to connect them with their peers to learn and share information with each other and benchmark against each other. And we continue to offer cutting-edge programs on the topics that are most important to them.

We do some employer-directed research projects; they're not scientific, they're not academic, but looking at things that are new to the market that help benefit our employer members. They can't rely on their consultants all the time and their carriers and their vendors, as they are often focused on other things and profitability. So they're really working with us as a coalition to learn from each other. And we continue to focus on what's most important to them and sharing the truth and being transparent about what's going on in the marketplace, who's increasing their costs. And if you're increasing costs, and you're providing value, that's great. But if you're not providing value, what can the employer do about it.

So we try and share with them ideas and strategies for that. And that goes whether it's for health benefits or health improvement programs or chronic condition programs or specialty drug management. How can they look at ways to get rid of the waste and the low-value care, which is pretty prominent. If we could get rid of the waste and misuse and overuse and low-value care in health care today, that would be a huge savings and we would all be in better shape.

Part of that is the way the system is designed. The other part of it is it's designed to be confusing, so that we don't know how much things really cost.

Read part 2 of this interview tomorrow.