Cancer is second only to heart disease as the most common cause of death in the United States1. The good news is that the number of cancer survivors has increased, thanks to advancements in prevention, screening and treatment.
From a financial perspective, cancer costs have consistently remained within the top three health plan medical expense categories. This is unlikely to change as medical expenditures for cancer in 2020 are expected to increase 27 percent over 20102. The health care system is at a critical juncture in determining how to control costs while continuing to meet care needs. Unfortunately, several trends will continue to make it difficult to reconcile the two.
Trends impacting cost of cancer care
- Population trends drive higher cancer rates
- Advancing science increases costs
- Higher survivor rates extend the treatment cycle
- Site of care impacts cost
- Providers paid for activity, not outcomes
Best-practice model focused on improving outcomes
A care model incorporating both evidence-based medicine and targeted case management can help reduce costs and improve quality of care. Care model success depends on the following:
- Treatment decision support technology — web-based platforms help put the latest, most accurate library of cancer treatment protocols, clinical trial results and estimated treatments costs at provider’ fingertips.
- Early patient identification and engagement — Identify and engage patients early on to guide them toward evidence-based treatment, which is more financially feasible and delivers better outcomes.
- Specialized oncology case management — Managing cases through specialized oncology nurses can help to improve patient engagement and reduce cancer related medical costs.
- Multidisciplinary care management team — Patient needs are better met when managed by a team, usually comprised of an oncology nurse case manager, medical oncologist, social worker and others.
- Specialized provider networks — Partnering through oncology specialists helps to lower costs by ensuring patients receive the most effective, outcome-based treatment.
- Bill audit system — Such a system can ensure reimbursement aligns with approved treatments, medical policy and the member’s benefit plan.
- Ongoing commitment to continuous quality improvement — Payers and members benefit when cancer care models embrace a disciplined approach to continuous improvement.
For a continued discussion on this topic, register for our webinar, “Managing the unpredictable and accelerating cost of cancer care.”
1American Cancer Society, Cancer Facts and Figures, 2015.
2Mariotto, Journal of the National Cancer Institute, 2011.
About the author
Melissa Lindholm, MBA, Six Sigma Certification, Senior Director Oncology, Optum
Melissa Lindholm is an established business leader specializing in oncology solutions and Business Development. She has more than 15 years of healthcare experience and has focused on cancer solutions for the last eight years. Presently she leads the business operations for the cancer suite of services. She is focused on delivering value by improving the quality of patient care while mitigating costs.