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    Five approaches to effective cancer care management


    During the next year, 1.7 million people in the U.S. will be diagnosed with cancer and more than 600,000 will die from the disease. Nearly 40% of Americans will be diagnosed with some form of cancer during their lifetime. Despite an investment of more than $500 billion (2012 dollars) since 1971, progress on preventing, diagnosing, and treating cancer has moved slowly, at best, for many of the deadliest cancers. Hopefully, that trend will change as new treatments recently approved by the FDA as well as promising treatments in the pipeline have the potential to be game changers in the fight against cancer. 

    For health plans, managing the care for members with cancer is unlike managing care for other chronic diseases. To start with, there are more than 100 different types of cancer, each with multiple treatment options based on the stage of the disease, patient's age, and overall health. Add to this the wide variation and veracity of information that is available from the Internet; well-meaning family and friends, ads touting treatment approaches and cancer centers, and even the divergent treatment options that a patient’s oncologist may offer. The result is that members are often desperate for information and help in knowing what to do.

    Here are five approaches to effective cancer care management:

    1. Steer members to providers with demonstrated adherence to the most efficacious treatments available.

    2. Use provider incentives that encourage the use of clinical guidelines and pathways for cancer treatment and reduce authorization and pre-certification requirements for providers that use them.

    3. Provide members with information appropriate to their treatment process including side effects; optimum dietary, exercise, and other wellness practices; and when to notify their provider about concerns. This can help empower members and improve their treatment process.

    4. Augment these actions with a 24/7 specialty nurse call line members can use to discuss any aspect of their care. This can reduce inappropriate emergency room utilization, as well as offer a calming voice in times of anxiety, confusion, or depression.

    5. Make oncology nurse navigators available to members. They can coordinate the care for the patient and their family in all aspects of the patient’s life including providing education about their disease and clinical trials; explaining treatment options and side effects; scheduling appointments and arranging for transportation; and helping them deal with the impacts of treatment on other aspects of life including finances and life after treatment. The Oncology Care Model, a five-year study rolled out last year by CMS, incorporates the use of oncology nurse advocates and is already demonstrating early positive results by decreasing the unnecessary use of emergency rooms.

    Because the incidence of cancer increases with age, nearly 80% of all new cancers will be diagnosed in people over age 55, health plans can expect to cover more members with cancer. Developing approaches to better manage all aspects of care for those with this disease should be a key priority for the managed healthcare industry.


    Don Hall MPH, a former health plan CEO, is principal, DeltaSigma LLC, in Littleton, Colorado.




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