Cancer management demands evidence-based care


Plans tackle cancer treatment

HallFew diagnoses have the devastating impact that a diagnosis of cancer has. Despite significant improvements in treating many types of cancer, the diagnosis is often received on the part of a patient and his or her family with a sense of doom and panic about what to do and where to go.  

After the reality of the diagnosis sinks in, a furious Internet search begins in a desperate attempt to find answers about treatment and prognosis. Sadly, what will be found is an extremely wide variation in treatments, costs and outcomes. Next, well-meaning friends and relatives will inundate the patient with a full spectrum of stories ranging from horror to miracles about cancer treatment.  

Even among providers, those diagnosed with cancer will encounter different and often conflicting perspectives on the best treatment path for their specific cancer. 

In the next year, over 1.6 million Americans will receive a cancer diagnosis and began their journey through this process-with too little objective help to guide them.

Improved savings, adherence and outcomes 

Health plans have largely stayed away from managing cancer care in the same way as other chronic diseases because of the fear of the perception that the health plan is placing costs savings over potentially lifesaving treatments, as well as the relatively low cost of cancer treatment as a percentage of the overall health plan medical spend.  

This is quickly changing as the costs of treatment, wide variation in care and outcomes, and patient confusion become more pronounced. New initiatives that focus on aligning provider payment with evidence-based treatment guidelines already have demonstrated significant savings, better adherence to these guidelines and ultimately better outcomes.  

Other initiatives have included working with providers to deliver member support and education about treatment side effects and appropriate home care specific to the treatment plan.  


Balancing act

Moving into a more pronounced role in managing care for members diagnosed with cancer heralds a new and potentially positive era for demonstrating the value of health plans in effectively balancing costs and quality to assure the best possible outcomes for members.   

However, missteps in developing or implementing these initiatives can seriously backfire with both members and providers. Because of the rapidity of changes in cancer treatment, particularly in the area of pharmacology, it is critical that a health plan stay at the forefront of evidence-based care and develop its initiatives around the appropriate combination of data, plan design, provider payments and member support.  

Once established, these programs will need to incorporate mechanisms to be adaptive to the changes in the care and treatment of cancer. It’s also important for health plans to design these initiatives in ways that support and complement the efforts of those providers who are following evidence-based care guidelines.

Ultimately, health plans need to step up and take a more active role in helping their members who are diagnosed with cancer. By properly establishing and managing a comprehensive approach to supporting the most effective treatments, they can help resolve some of the confusion surrounding members who are coping with cancer. 

Hopefully at the end of the day, health plans can demonstrate that they can assure better outcomes while also reducing the cost of care for their members.  

Don Hall, MPH, is principal of DeltaSigma LLC, a consulting practice specializing in strategic problem solving for managed care organizations. He also is an editorial advisor for MHE. 

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