While cancer continues to be one of the most common causes of death in the United States — exceeded only by heart disease — there is some good news. Prevention and early detection/treatment are improving five-year survival rates, with clinical care and treatment options advancing as more is understood about the disease.
Complex care, complex costs
Higher survival rates and more complex treatments also translate to higher costs. According to the National Cancer Institute Cost Projections Health Organization, direct cancer costs will total $207 billion by 2020.1 Several factors contribute to this, including:
- The number of cancer patients is growing as the population ages
- Improvements in diagnostics and treatments are increasing the number of cancer survivors
- Development of new and costly cancer drugs
- New technology such as radiation treatments
Increasing cost of treatments and provider mergers with hospitals are also creating greater cost burdens to payers. In the past, oncology practitioners were paid based on fee for service basis. Typically, 60–70 percent of a provider’s revenue would come from drug margins. As the cost of drugs and services increase, and as payers cover facility fees that were not covered under provider payment models, payers are feeling the pressure of the accelerating costs.
Maintaining cost-effective quality of care
To thrive in this challenging time requires an understanding of each stakeholder’s primary goals.
- Clinical providers want to achieve the best outcomes in the most efficient and effective way.
- Patients simply want to survive, and they need the best support to understand their path forward given their specific situation.
- Payers need value-based business models that enable them to improve quality of care, so they can attract more members and increase business growth.
With an understanding of each stakeholder’s key drivers, payers can establish a comprehensive cancer care strategy based on best practices, and deliver proven value for quality processes.
For more insights into how this can be achieved, visit our oncology webpage to download the white paper, “Oncology issues and solutions: The value of comprehensive care”
National Cancer Institute Cost Projections Health Organization
About the Author:
MBA, Six Sigma Certification, Senior Director Oncology
As Senior Director of oncology, Melissa Lindholm leads the product strategy, development and growth of oncology related end-to-end solutions for commercial, Medicare and Medicaid clients; including network solutions, patient case management and provider care extension and decision support products.