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To Expand Access to Cancer Expertise, Collaboration Is Key
Either directly or indirectly, nearly every person in the United States has been touched by cancer. With approximately 2 million new diagnoses every year, it is hard to not have a connection to the disease personally or through a loved one, friend, or colleague.1 Fortunately, cancer research is always progressing, with understanding of the disease and its treatments expanding every day. In 1950, medical knowledge took approximately 50 years to double, but today this same level of progress is estimated to take only 73 days.2 Although researchers continue to push these boundaries, the latest cancer care expertise remains out of reach for many patients and community oncologists.
National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers are predominantly located in urban areas, with 53 facilities in 30 states and the District of Columbia.3 This leaves the 46 million individuals who live in rural communities—approximately 15% of the US population—without access to cutting-edge cancer facilities, with some required to travel hundreds of miles to see an oncology subspecialist.4 Because of these geographic barriers and other factors, only 20% of all US patients with cancer are seen at an NCI facility, leaving the vast majority unable to benefit from the innovations unfolding across the industry and the highest-quality, evidence-based care.5
This burden is not only felt by patients and their families but by many employers, who often lack effective solutions to address cancer in their employee population. In fact, cancer is now the leading driver of health care costs for large employers, accounting for 12% to 15% of medical spend.6
In 2020, AccessHope was launched by City of Hope, one of the largest cancer research and treatment organizations in the nation, to change the way cancer expertise is delivered across the country by mobilizing remote access to oncology experts from leading-edge NCI-Designated Comprehensive Cancer Centers. AccessHope quickly forged partnerships with other like-minded organizations, and most recently partnered with Carrum Health, the first digital health company to connect employers and employees to Centers of Excellence (COEs) through a technology-powered, value-based care platform.
As the CEOs of AccessHope and Carrum Health, we have each seen the impact our work can have on bridging knowledge gaps in the always advancing field of cancer research. Together, we are beginning to reach our full potential. Our teams aim to extend remote specialized cancer expertise and support to more patients nationwide, facilitating access to leading-edge insights and research for local oncologists, improving patient experience and outcomes, reducing geography-based health disparities, and lowering costs. Members can now benefit from remote expertise from national specialists who are knowledgeable in the latest cancer discoveries, treatment plans, clinical trials, and personalized precision medicine opportunities—such as new immunotherapies and evolving genetic assessment and management of cancer—for all forms of cancer, as well as experienced oncology nurses who can offer information and support.
For communities that historically may have not had access to this level of cancer expertise, partnerships such as this are essential to reduce health disparities and avoid low-value care for employers and their employees, especially given that cancer care costs are expected to rise as much as 30% between 2015 and 2030.7
Addressing Geographic Health Disparities
The contributing factors to cancer are complex, with geographic hurdles causing stark gaps between treatment and outcomes. Survival rates are higher for patients treated at NCI-Designated Comprehensive Cancer Centers than those treated at local hospitals, and individuals in rural areas are already likelier to experience disparities in cancer outcomes due to social determinants of health such as lower socioeconomic status, higher rates of tobacco use, poor diet, lower vaccination rates for viruses such as human papillomavirus, and lower awareness of cancer risks and benefits of screening.8 Although research advancements can lead to improved rates of survivorship overall, we have seen mortality rates decline at a slower pace in rural areas.
The partnership between our organizations extends insights through AccessHope’s elite network of cancer subspecialists and expert oncology nurses to Carrum Health’s participating plans, broadening our reach to employers and employees across the United States. This builds on AccessHope’s ongoing efforts to expand cancer support services that remotely connect employees, families, and community-based oncologists to multidisciplinary specialist expertise from NCI–Designated Comprehensive Cancer Centers. We are expanding our national footprint through a network of foundational partners that reaches all corners of the United States, including City of Hope, Dana-Farber Cancer Institute, Emory Healthcare and Winship Cancer Institute of Emory University, Fred Hutchinson Cancer Center, and Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
Alongside AccessHope’s network of experts, this collaboration connects Carrum Health employer partners and eligible employees to other COEs within the Carrum Health network, delivering all-inclusive cancer programs that ensure that every cancer patient has access to high-quality, appropriate care. Carrum Health’s program features remote expertise from AccessHope’s network that supports all cancer types, all stages, wherever a member resides, and provides 100% of patients access to expertise from cancer specialists in collaboration with their local oncology team. In addition, patients have access to 1-of-a-kind treatment programs for breast, thyroid, and blood cancers, to name a few, from Carrum Health COEs. This is delivered through prenegotiated pricing (bundles) for cancer services including provider, facility, and treatment fees (surgery, radiation, and systemic therapies, which are the major cost drivers of cancer care).
Bridging these connections with remote technology can lessen the gap in treatment outcomes and survivorship between rural communities and metropolitan areas, reduce cancer health disparities in underserved populations, and broaden access to a wide range of cancer expertise—enabling patients to benefit from the most up-to-date innovations in cancer care without having to travel far from home or compromise their quality of life.
Managing Increasing Cancer Costs
Further exacerbating these gaps in care is the ever-increasing financial strain cancer places on our entire health care system. Today, employers are paying an average of more than $20,000 per employee for their health benefits.9
But in our traditional fee-for-service payment model, accountability for both cost and quality of this care is lost. Prices for the same procedures can vary dramatically depending on where they are performed, with limited association to quality.10
Working together to combine the remote expertise of national specialists knowledgeable in the latest cancer discoveries, we can help support a shift to value-based care, swiftly advising on optimal treatment plans for the best possible outcomes, reducing avoidable and wasteful expenses on unnecessary tests and treatments, while minimizing adverse effects and toxicity for patients.
This model of remote cancer expertise delivery has been validated in a peer-reviewed study published in JCO Oncology Practice that examined case reviews of patients with lung cancer.11 In 93% of cases reviewed, subspecialists from AccessHope’s NCI foundational partners made recommendations to improve efficacy, reduce treatment toxicity, and enhance care. Of these, significant changes were recommended in 28% of cases, and modest refinements were recommended in 65% of cases.11
Additionally, many of these recommendations were associated with cost savings. In 13% of the cases reviewed, the NCI subspecialist identified low-value interventions that could be eliminated, which could have led to an average cost savings of nearly $150,000 per patient, or more than $19,000 per patient across all cases reviewed.11
With a cancer roadmap in their complex care response such as that provided by AccessHope’s Accountable Precision Oncology service, overall employers are realizing a return on investment of 3:1.
Similarly, Carrum Health’s treatment program has generated 20% savings per cancer episode for employers. This is delivered through prenegotiated treatment bundles that financially incentivize COEs to provide high-value cancer care, including appropriate, evidence-based care; proactive symptom management; and cost-effective treatments (eg, biosimilars). These bundles include comprehensive support services, expert diagnosis, and treatment planning, along with delivery of treatment and follow-up care. By bundling all aspects of cancer care, including chemotherapy, which can account for more than half of total costs, employers also gain predictability and visibility—with little to no out-of-pocket cost to patients, removing financial toxicity often associated with cancer.
Personalizing Cancer Support for Employees
Given growing cancer diagnoses, there is a critical need to reduce health disparities for those with this disease to ensure equitable outcomes.
Employers have an opportunity to take on this charge by providing their employees with more flexible and personalized benefit options, including addressing the needs of individuals with cancer. These options can include resources to address mental, emotional, and financial health while also offering more personalized cancer-focused services, providing employees peace of mind so they feel supported throughout their journey.
When employers provide benefits that are in line with employees’ needs and values, they see great returns. Benefits such as those provided by AccessHope and Carrum Health have been shown to boost employee morale, foster healthier work environments, and attract and retain top talent. In addition to the individual impact on employee health and wellness provided to their teams, offering personalized cancer support also enables organizations to participate in the greater fight against negative influences of social determinants of health, creating a better future that extends well beyond company walls.
We have an opportunity to make tremendous progress in how we support those affected by cancer—allowing anyone, anywhere, to benefit from the extraordinary innovations happening across the field of oncology. But to bring these offerings to life, organizations across the health care system must recognize the strengths of their services as well as where they may fall short and benefit from collaboration and the expertise of others.
By listening, learning, and collaborating with one another we have an opportunity to expand our ever-growing body of cancer research and encourage knowledge sharing across the oncology community while giving employers the tools to ensure those with cancer experience optimal outcomes, close to home.
Author Information
Mark Stadler, BBA, is the CEO of AccessHope. Sach Jain, MBA, is the CEO and founder of Carrum Health.
References
1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA: Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763.
2. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
3. Choosing a cancer center or hospital. American Cancer Society. Updated September 17, 2021. Accessed January 17, 2023. http://bit.ly/3IUYKLC
4. About rural health. Centers for Disease Control and Prevention. Updated August 2, 2017. Accessed January 17, 2023. https://www.cdc.gov/ruralhealth/about.html
5. Data table 3: reportable patients/participation in therapeutic studies. National Cancer Institute. Accessed January 17, 2023. https://cancercenters.cancer.gov/DT/DT3
6. Shockney L. Paying attention to cancer pays off for your employees. Johns Hopkins Medicine. September 2017. Accessed January 17, 2023. https://www.johnshopkinssolutions.com/paying-attention-cancer-pays-off-employees
7. Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol Biomarkers Prev. 2020;29(7):1304-1312. doi:10.1158/1055-9965.EPI-19-1534
8. Sengupta R, Honey K. AACR Cancer Disparities Progress Report 2020: achieving the bold vision of health equity for racial and ethnic minorities and other underserved populations. Cancer Epidemiol Biomarkers Prev. 2020;29(10):1843. doi:10.1158/1055-9965.EPI-20-0269
9. Palosky C, Ducat S. Benchmark employer survey finds average family premiums now top $20,000. Kaiser Family Foundation. September 25, 2019. Accessed January 17, 2023. https://www.kff.org/health-costs/press-release/benchmark-employer-survey-finds-average-family-premiums-now-top-20000
10. Kennedy K, Johnson W, Rodriguez S, Brennan N. Past the price index: exploring actual prices paid for specific services by metro area. Health Care Cost Institute website. April 30, 2019. Accessed July 17, 2023. https://healthcostinstitute.org/in-the-news/hmi-2019-service-prices
11. West HJ, Tan YA, Barzi A, Wong D, Parsley R, Sachs T. Novel program offering remote, asynchronous subspecialist input in thoracic oncology: early experience and insights gained during the COVID-19 pandemic. JCO Oncol Pract. 2022;18(4):e537-e550. doi:10.1200/OP.21.00339
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
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