Tom's Take Blog

September 26, 2018

Are there any effective ways for health plans to manage today’s high-cost cancer treatments?

According to research shared by the American Cancer Society, an estimated $80.2 billion was spent in just one year on cancer-related health care in the U.S. If you take things like labs, diagnostic imaging, provider visits, drug costs, surgical costs and extended hospital stays into account, it’s easier to understand why this number is so high. And as breakthroughs continue to occur and so many treatments become more advanced, the price tags will keep getting higher.

 

This is why programs and solutions for cancer risk management are starting to gain traction and be implemented by health plans. At Cypress, we offer them to our clients as a way to be proactive about managing costs, but even more so as a way to ensure that members are getting the best care by condition.

 

Some of the savings- and quality-focused elements that are incorporated into these cancer care solutions include:

  • Plan language recommendations to specifically address what kind of cancer care is covered in the plan upfront and provide definitions.
  • A risk level process that includes predictive modeling to forecast an estimated number of cancer care cases each year, and then classifies actual cases by the level of care required to assist with cost planning.
  • A triage approach to care that focuses on engaging with members who are newly diagnosed and directing them to the appropriate channels.
  • The importance of second opinions, as a different diagnosis could mean a totally different course of treatment.
  • A collaborative effort in the decision-making process, with guidance for members and their families in choosing the most effective and appropriate cancer treatment.
  • Treatment recommendations that follow National Comprehensive Cancer Network (NCCN) guidelines by cancer type.
  • Partnerships with Cancer Centers of Excellence.

 

Think of the billions spent on cancer care in this nation each year and then consider this: We may not be able to control the price tag, but we can be smart about implementing cost containment measures with our health plans – while ensuring access to high-quality care and improved outcomes for plan members.

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