In 2022, for the first time ever, cancer surpassed musculoskeletal as the top condition driving large self-insured employers’ health care costs. So it’s no surprise that the vast majority of employers are now actively seeking solutions to improve their cancer care benefits. In fact, in a recent webinar sponsored by Carrum Health, 96% of attendees said cancer is a top 5 near-term priority for their organization. In addition to the high and rising costs, employers also realize the tremendous potential to improve the patient experience and quality of care.
“Value” from the employer's perspective
“Value” is a term that gets thrown around a lot in health care. And at a baseline level, most of us agree it involves things like outcomes, quality, satisfaction, safety, costs. However, value is in the eye of the stakeholder – it will be defined and measured differently depending on your industry, background, field of expertise, goals, and myriad other factors.
This holds true for self-insured employers. Sure, some of the ways they perceive value will overlap with other stakeholders, but there are also important nuances to consider. For example, they may be more concerned with long-term cost management (especially if they have low employee turnover) and offering attractive benefits (especially if they operate in a competitive industry). Some specific factors they may use to measure value of cancer solutions include the ability to inflect:
- Costs (per episode and overall)
- Quality of care and outcomes
- Appropriateness and utilization
- Access to high-quality providers and innovative treatments
- Member experience
- Productivity and absenteeism
- Employee retention and satisfaction
How providers should prepare to demonstrate value to employers
There are many strategies by which cancer providers can engage self-insured employers – ranging from strategic partnerships with local employers to offering virtual second opinions to participating in a Centers of Excellence (COE) platform.
Full disclosure: I spend my time building out COE programs for commercial lives. In my opinion, any program worth its merit is going to ensure that the COEs in its network are high-value and can demonstrate that value. For me and my team, that involves looking at a number of data points that reflect cost-effectiveness, quality, and member experience, such as:
- Patient satisfaction
- Rate of adherence to clinical pathways (or NCCN guidelines)
- Performance on end-of-life care metrics
- Rate of ED visits and hospitalizations following chemotherapy
- Volumes
- Clinical trial accrual
- Investment in patient-centered support services
Whether or not participating in a COE is the right move for a cancer program, one thing is clear: Given employers’ growing interest in cancer care, providers need to consider them a critical stakeholder in strategic growth planning moving forward.
To continue exploring the self-insured employer space, check out our Cancer Care Business Breakthrough video series here.
