What to Do About Cancer: Desperate to Curb Costs, Employers Reach Out to Disease Management

Health Enhancement Newsletter
Matria Healthcare
Published October 2004

Because cancer is not one disease, but really 125 different kinds of abnormal tissue growth and is terminal for at least one-third who get it, employers in the past have been reluctant to take on the complexity and emotional burden associated with managing cancer.

But what many employers do not realize is that advances in scientific research that allow for early disease detection and reduced mortality are expected to contribute to an estimated 50 percent increase in the number of people living with cancer between 2000 and 2015.[1]

Cancer is already the second most costly and lethal disease in the United States after heart disease at $170 billion annually. It accounts for 15 percent of all medical expenses for health plans.[2]

Because cancer patients are living longer with their conditions, they are incurring additional and greater treatment costs. New biotech compounds that allow for the disease to be treated with a once-a-day pill can cost up to $45,000 a year in added treatment costs. A rapidly aging population also is expected to contribute to costs, as 77 percent of all diagnosed cancer cases occur in people 55 years of age and over.[3]

For the past three years, employers have been implementing programs for costly chronic conditions, such as diabetes or heart disease, but purchasing only components of disease management programs for their employees who have cancer, according to a 2003 report published by Quality Oncology (QO), the nation's largest and most experienced provider of cancer disease management programs. The report, titled Disease Management & Health Outcomes, is available on the company Web site at www.qualityoncology.com.

Because cancer patients are surviving longer and experiencing remissions that last more than five years, they are beginning to be as much of a drain on employer budgets as employees with chronic conditions, according to the report, written by Rick Lee, vice president of sales and marketing for Quality Oncology and founder of Accountable Oncology Associates, which merged with QO in 1998.

Not only must employers now foot the bill for healthcare costs when cancer patients cycle in and out of remission, they also must pay for the lost productivity and absenteeism that result when these patients go back into treatment, Lee writes. He also points out that the cost of cancer to employers is actually greater than that of health plans because most of the $170 billion annual cost of cancer is due to $110 billion from lost productivity, absenteeism and presenteeism.[4]

Key Cost Drivers

A lack of educational information to help patients lessen side effects, as well as physician deviation from evidence-based guidelines and the absence of a case manager directing the patient's treatment all contribute to unnecessary hospitalizations, emergency room visits and prescriptions.

And similar to chronic conditions, uncoordinated care by different medical providers and institutions results in duplicate diagnostic tests and screenings. Additionally, a lack of counseling and informed consumerism sometimes leads to a wasteful continuance of aggressive, hopeless, curative treatments when supportive hospice care would be a better and more realistic option for the patient.

Case Management Solution

Cancer disease management relies heavily on skilled oncology nurses acting as case managers, who coordinate the patient's treatment. Nurse case managers develop trusting relationships with patients and their family members, working with them to ensure treatment plan compliance. Along the way, they provide education about the disease, side-effect management and help interpreting information received by doctors.

Nurses also monitor physician compliance with evidence-based guidelines. Sometimes, in an effort to be responsive to a patient when a treatment does not appear to be working, even physicians may deviate from scientifically proven treatment guidelines.[5] As a result, important aspects of treatment can be overlooked, such as making sure patients obtain follow-up chemotherapy treatments after alternative or even routine surgical procedures.[6] Nurses also manage the flow of information between multiple physicians, oversee pain management to ensure comfort and avoid unnecessary hospitalizations and coordinate end-of-life care.

Successful Outcomes

Comprehensive cancer disease management programs are designed to improve clinical outcomes and quality of care, increase member and provider satisfaction and reduce unnecessary inpatient utilization when an appropriate, lower-cost setting is available; readmission rates; inappropriate laboratory and diagnostic tests, and side effects from treatments

While employers have not as yet been flocking in droves to sign up for full cancer programs, they have been seeing amazing results through their health plans.

• In a two-year cancer study, Blue Cross Blue Shield of Florida reported a 7 percent reduction in readmissions and an 11 percent reduction in hospital days.[7]

• CHA Health reported a 54 percent decline in average costs for supportive drugs, 50 percent fewer inpatient admissions for chemotherapy, a 36 percent reduction in admissions for pain control and a 24 percent cut in the rate of readmissions.

As these successes become more publicized within the healthcare industry, it will become harder for employers to deny that cancer disease management programs are making a positive contribution toward the reduction of healthcare costs.

[1] SRI Consulting, C4: Cancer Opportunities in the New Millennium, Menlo Park, CA, SRI Consulting, 2000.

[2] Oncology News International, "The Florida Blues' Experience in Improving Cancer Management," David L. Teitelman and Frederick C. Lee, May 2002.

[3] Quality Oncology, Disease Management & Outcomes, "Employer-based Disease Management Programs in Cancer," Frederick C. Lee, 2004.

[4] Ries LAG, Kosary CL, Hankey BF, et al. Seer Cancer Statistics Review, 1973-1999. Bethesda ( MD): National Cancer Institute: NIH publication no. 97-2789, 2003.

[5] Oncology News International, "The Florida Blues' Experience in Improving Cancer Management," David L. Teitelman and Frederick C. Lee, May 2002.

[6] Ibid.

[7] Ibid.

[8] Ibid.