Time to Address ‘Financial Toxicity’ of Cancer Treatment

MHE PublicationManaged Healthcare Executive November 2018 Issue
Volume 28
Issue 11

More affordable, more collaborative, and more personalized care is our cancer care challenge. Here’s how we get there.

Cancer image

In 1975, a cancer diagnosis of any kind meant a patient had less than a 50% chance of surviving more than five years. Today, that five-year survival rate is closing in on 70%. And the rate is much higher for certain cancer sites, so long as the cancer is detected at an early stage.

Clearly, we’ve come a long way in 40 years-but we still have a long way to go. Cancer care needs to be more collaborative and evidenced-based. It needs to be more focused on prevention and psychosocial wellness. And on top of all that, it needs to be more affordable and accessible.  

Related article: Opinion: Top Trends Influencing the Future of Affordable Cancer Care

So how do we get there?

Personalized Care 

When we speak of “personalized medicine” in the context of cancer care, we’re often referring to next-generation genomic sequencing, data science, targeted therapies, and immunotherapies.

And those are vitally important weapons in our ongoing fight against cancer. But personalized care is much bigger than that-it’s about a holistic approach to multidisciplinary care coordination. From the moment of diagnosis to a patient’s final treatment, at every point along the care continuum-surgery, radiation, pathology, imaging, chemotherapy, dietary, rehab-the care needs to be precisely organized around the patient’s convenience, preferences, and best interests.  

I’ll give you an example: In recent years, some health systems (including ours) have opened after-hours oncology clinics. Many cancer patients experience side effects to their care-nausea, pain, fever and more-and if the symptoms hit after 4 p.m., those patients may require a trip to the emergency room. But an ER is the last place a cancer patient should be, because of increased susceptibility to the types of infections that are often present in a hospital emergency setting.

These after-hour oncology centers are open late (and in some cases, 24/7), and they provide safe care alternatives for cancer patients with urgent symptoms. This leads to better outcomes.

Provider-payer Collaborations 

Providing comprehensive cancer care is an all-in effort that, increasingly, requires investment and creative thinking from payers, too. Over the last several years, insurers across the country have become more involved, and it’s a trend that will accelerate.

The partnerships make sense. Insurers have a wealth of claims data that can be beneficial to oncologists, and oncologists possess the clinical data and up-to-date technical knowledge that is required to make timely treatment decisions. Carriers have also developed bundled payment models for clinics that adhere to certain best practices, as determined through real-time collaboration with staff oncology experts. And some insurers are considering payments for remote oncology care and out-of-the-office triage, which allows practices to deploy clinical resources in nontraditional ways.

Financial Wellness 

It’s no secret that cancer care is expensive, in America and around the world. Yes, we’ve made remarkable progress in understanding and treating cancer, but the truth is that our current delivery models provide those treatments at an unsustainable cost.

Related article: Three Best Practices for Welcoming New Cancer Patients

A lot of that cost is tied up in the latest oral medicines and cell-based therapies, which can run hundreds of thousands of dollars per year (or per even dose). But there are other, systemic costs that we as providers and insurers must work to address if we want to reduce the budget stress and “financial toxicity” of cancer treatment. Our challenge in the years ahead is to ensure that cost of care reflects the value of care-because when the cost of cancer care is prohibitive, we’re doing a poor job of serving our patients and their families.

Cynthia Hundorfean, a Managed Healthcare Executive editorial advisor, is president and CEO of Allegheny Health Network (AHN), an integrated healthcare delivery system that serves Western Pennsylvania. AHN is part of the Highmark Health family of companies.

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