Oncology Cost Management Strategies

In our latest In the Booth podcast, we are pleased to have Bridgette Cassety from broker engagement, Tina Etzler, a senior strategic consultant from the product team, and Jenny Shanks from Market Intelligence discussing the drivers that are affecting oncology costs and strategies for our employers to proactively plan and manage these costs.

Transcript

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Speaker 1 (00:08):

Welcome to another edition of In the Booth. My name is Bridgette Cassety and I'm head of broker engagement here at Meritain Health. And I appreciate you joining us for today's discussion, which is centered primarily on cost containment strategies for oncology. And before I introduce our guest today, if you listen to one of our more recent podcasts, you know that we discussed medical inflation, which is certainly a hot topic. And while the impact has not yet been seen as widespread as maybe other economic drivers, it is certainly expected to follow suit. So knowing this and looking at what conditions are driving healthcare costs, a lot of employers and our brokers are obviously looking for ways to mitigate them before they occur. And we all know that one of the highest impacts to employers year over year is certainly oncology care. So today we're going to discuss what we're seeing trend-wise when it comes to the drivers that are affecting costs and strategies for our employers, and how we as plan sponsors, as brokers, can proactively plan and manage the cost of our oncology spends together.

Speaker 1 (01:07):

So I'd like to begin by introducing our guest, Jenny Shanks, who's been with us before from Market Intelligence, and Tina Etzler from product. So I want to thank you both for joining me today and just let's get right into it. Jenny, I thought we'd start with you and maybe you can give us an overview on some of the trends that you're seeing in the industry. I know in your role you continue to monitor that for us as a company and for our customers. So maybe you can just give us, a bird's eye view of what you're seeing.

Speaker 2 (01:36):

Yeah, I'd be happy to. So I'll start first with some information from the business group on health. They hold an annual large employers healthcare strategy and plan design survey. And for the first time in the history of that survey, cancer was the most commonly reported condition driving healthcare costs. And that's overtaking a skeletal or MSK. In that study, 83% of employers surveyed said that cancer is among their top three conditions driving healthcare costs and trends. And then additionally, , sun Life book out their annual high cost claims and injectable drug trends analysis. And in 2022, that analysis showed that cancer was in the top two high cost claim conditions. And in some life study they separate two different categories. You've got malignant neoplasms, and then the other cancer category would be leukemia, lymphoma, and multiple, multiple myeloma. So those conditions together, the cancers, they've consistently been in the top two over the past four years at least.

Speaker 2 (02:46):

But what stood out to me in that study is that the total stop loss claim reimbursements made by Sun Life for those cancers combined have reached 1.5 billion over the past four years. And if you compare that to the next highest reimbursement category, which is cardiovascular, and the past four years, that reimbursement amount has been 390 million. So that's a difference of almost four times. And if you're looking at not just cost, if you're looking at prevalence as well, what we're seeing is that really they're both rising both cost and prevalence, and that's driving costs. So for prevalence, in that sunlight report, it showed that there was an increase of individuals with a cancer claim, a 39% from 2018 to 2020, or excuse me, 2021. So pretty significant over those four years.

Speaker 1 (03:41):

Yeah, Jenny, I think that some of the numbers you throw out there when you start to talk about, the cost in terms of billions of dollars, that certainly gets everybody's attention, especially when you're seeing it increase both in cost and prevalence. So I think you've done a great job of sort of framing up the challenge that our customers are faced with. So Tina, could you maybe share some of the ways, that employers can be more proactive when thinking about this rising cost that Jenny referenced related to oncology costs?

Speaker 3 (04:09):

Sure, I'd be happy to. I think there's really three different approaches that you could take when you're thinking about this. One is to be proactive in, in mitigating plan costs in general with your plan setup and your benefit design. Those are things that you can focus on. You can also give members knowledge and tools for them to engage in their own care and research prior to getting a diagnosis. And then also the engagement that we can have with members to programmatically intervene and help them to manage their care. Those are the three things I think of first, regarding that first one, really what it is, is about how are you going to control access for your members to the network relative to oncology care. And so typically you want to have strong design in accessibility to providers, but you also may want to highlight quality providers and or lower cost providers through tools that you give to the member, like Healthcare BlueBook, and making sure that you consider whether you want to build in any benefit tiers where going to certain providers have some kind of incentive for them, like maybe a reduced cost for benefit, things like that.

Speaker 3 (05:22):

So there are things that you can do to manage your network in a really strong way.

Speaker 1 (05:27):

Jenny, from your perspective, you know, what, what did you see or what, what are you seeing in the data when it comes to the impact of covid on prevention?

Speaker 2 (05:38):

Yeah. We know that it's not a surprise to anyone that many routine screenings were delayed. Some were even missed during the pandemic, and that is now contributing to a higher prevalence of late stage cancers, which means that members are sicker and treatments are more intensive or more costly. And that is affecting the bottom line, not just for our, you know, the plan costs, but also the outcomes for our members. So it, it's really critical that members receive their cancer screenings. Early intervention we know leads to better outcomes for the patients. And treating earlier stages of cancer cases also helps mitigate costs for the plan.

Speaker 1 (06:21):

And Tina, I think you, you bring up a lot of good points. You, you always do a great job of sort of breaking down the opportunities into actionable items. And I, and I think the, the one thing that you really talked about that's so important is really giving members those tools, right? And, and making sure that they can engage with those tools. So can you maybe share a little bit more about that? Cause I know that's a hot topic that I continue to hear from our distribution channel and, and folks in the field is, is, you know, how can you achieve that, especially when you're talking about oncology?

Speaker 3 (06:50):

Sure. It's really important to share accountability with the member to make sure that you have a correct diagnosis. Oncology has a really high occurrence of misdiagnosis, and so really you want to support your member with maybe like a second opinion option in order to make sure that more than just one physician has maybe reviewed their case to understand what type of cancer they have and what the treatment model might be. Additionally to that, you want to make sure that you are encouraging your members to be good consumers of their own healthcare. And so you want to make quality information available to them. Like I mentioned, healthcare Blue Book would be one of the ways to do that. Another way also would be to encourage them to pay attention to preventative screening, which are things that, you know, having a mammogram once a year, for example, are ways that you can catch oncology cases a little bit earlier on in the process. So all of those are combined that are things that you can encourage members to do and be active about in their care.

Speaker 1 (07:56):

And I think you're right, getting that diagnosis correct is, is obviously critical and we've all heard those stories, from, from folks in our own lives about when that's not been accurate. And, and I think just to, just to peel this back a little bit further, Tina, could you maybe talk about, you know, once that correct diagnosis is made, what else can we do to support that member on the journey? So you sort of talked about, you know, what we can do to make sure it's preventive and they get the right diagnosis, but then after there's a diagnosis, what are the things that we can do, to support that with those folks?

Speaker 3 (08:29):

Absolutely. That's where the opportunity for us to programmatically engage with members who we can open a case for, an oncology case and we match up experience oncology nurses to assist them through that. They're going to review the plan of treatment, make sure that everything is meeting medical necessity, and also try to help steer when it comes to review of any of the treatment plan and getting them the right type of service that they need. So that's really where we can engage with the member by outreach letters and get them engaged in their care and making sure that we're walking beside them to help them understand what they need and what it costs.

Speaker 1 (09:10):

You know, a couple of things that I'm taking away from our conversation today, Tina and, and Jenny, is that, you know, to be proactive, right? These types of claims are out there, oncology costs and, and prevalence is on the rise. So to be proactive in those plants up is certainly something that I heard you both say slightly differently, and you have the same, member tools and resources and engagement are critical. So having that, what I'm going to call comprehensive strategy is really important for customers to achieve, maximum results of our about driving cost effective care, but also being member centric, keeping our members at everything that we do. I want to thank you both for joining me for this addition of Meritain in the booth, where we bring insights on solutions and strategies that help our customers reduce their total cost of care. We look forward to you joining us for next time.