Oncology Cost Management Strategies

Oncology Cost Management Strategies
December 13, 2022 Erica Manhardt

Oncology care is an area with one of the highest impacts to employer costs year-over-year. Many employers are looking for ways to mitigate these costs before they occur. Therefore, having reliable oncology cost management strategies can help.

Why are cancer costs rising?

Oncology case volumes are increasing and cancer treatment is more complex. Cancer care is also an area that continues to rapidly expand with the development of new treatments and technology. This impacts employer spend as a cost driver.

According to the annual Large Employers’ Health Care Strategy and Plan Design Survey from The Business Group on Health1, this year marks the first time cancer was the most commonly reported condition driving health care costs, overtaking musculoskeletal. In that study, 83 percent of employers surveyed said cancer is among the top three conditions driving their health care costs and trend.

Additionally, Sun Life’s 2022 High-Cost Claims and Injectable Drug Trends Analysis2 shows forms of cancer in the top two spots for high-cost claim conditions. These conditions, including breast cancer, leukemia, lymphoma and others, have been in the top two for the past four years. Total stop loss claim reimbursements made by Sun Life for these cancers (combined) have reached $1.5 billion over the past four years, compared to the next highest reimbursement category—cardiovascular— at just under $390 million.

Overall, cost and prevalence of cancer are rising. The number of individuals with a cancer claim has increased 39 percent from 2018 to 2021 (Sun Life’s report).

By working with Meritain Health®, employers can be proactive in their approach and develop oncology cost management strategies to lower costs.

We’ll work with employers to help address concerns using a three-pronged approach:

    • Mitigating costs proactively—through thoughtful benefit and plan design
    • Empowering members with tools—to actively engage in understanding their condition, plus varied options and costs of treatment before committing to a treatment plan
    • Supporting members fully with their physical and mental health needs—using Case Management, which provides medical review and resource coordination from an experienced oncology registered nurse.

Here’s a closer look at each of these tactics:

Mitigating costs proactively

Proactive planning when structuring plan design is important. This applies when considering oncology care and in general. For instance, adequate provider access for members is something every employer should consider. Also, enabling members to compare providers with a tool like Healthcare Bluebook can aid in them self-serving and advocating for their care. Finally, building benefit tiers for visiting certain providers with an incentive, like a reduced benefit cost, can also help mitigate costs.

Empowering members with tools

Once a member receives a cancer diagnosis, helping them understand their condition, treatment options and potential costs can make a difficult situation easier. You can help improve access and connect members to second opinions. Plus, making it easy to find providers to review their case, explain what type of cancer they have and what treatment models may look like can support members at a very emotional time.

Also, urging members to be good consumers of their health care can be beneficial. In recent years, putting off or missing wellness visits and preventive screenings due to the pandemic may have contributed to a higher prevalence of late-stage cancers. Encouraging members to actively participate in wellness programs, such as Healthy Merits, may lead to better health and overall lower costs for employers.

Supporting members fully with their physical and mental health needs

Having the right tools to manage care through programmatic intervention, while managing high-cost impacts, is important for members and employers.

Case Management is just one way members can access the support they need, through medical review and resource coordination from an experienced oncology registered nurse. Case Management nurses can work with members to review plan of treatment, confirm medical necessity, connect to services and help manage and support their care.

Cancer diagnoses can also impact mental health, for both patients and their families. According to The National Cancer Institute3, one in three people with cancer experiences mental or emotional distress. A cancer diagnosis can also amplify existing mental health conditions.

To support members beyond the physical component, Meritain Health offers access to Oncology Case Management with mental health support. Together, a Behavioral Health Case Manager and a member’s Oncology Case Manager collaborate to assist with holistic physical and mental health support.

For continuing care, the Meritain Health Medical Management Program has expanded services for oncology within Case Management. Cases for ongoing cancer treatment may shift to one of these options:

        • Oncology Maintenance
        • Oncology Maintenance Continued Care Coordination (CCC)

This allows individuals’ ongoing cancer cases to remain open, be monitored regularly and allows for engagement with members and providers, as appropriate.

Managing cancer care can be complex. So, we aim to help our members find the best care, while helping employers plan and execute smart plan designs that are affordable, accessible and consultative for oncology care.

Please reach out to your Meritain Health representative to learn more about implementing oncology cost management strategies to address your oncology cost spend.

1 https://www.businessgrouphealth.org/
2 https://www.sunlife.com/us/en/about/insights-and-events/2022-high-cost-claims-and-injectable-drug-trends-analysis/
3 https://www.cancer.gov/