As Cancer Becomes a Chronic Condition, Payers Shift Focus to Survivorship

Payers can do more to promote survivorship, but most have already made a significant start, said Ira Klein, MD, MBA, FACP, national medical director, Clinical Thought Leadership, Aetna. Klein’s talk, “Making the Grade on Survivorship: How are Payers Performing?” helped open Patient-Centered Oncology Care 2014, hosted by The American Journal of Managed Care in Baltimore, Maryland. While his remarks were specific to initiatives at Aetna, most insurers have a similar focus. The shift toward supporting survivorship is a natural result of more effective treatments, which means that cancer has become a chronic disease for many patients, requiring holistic, long-term management.

Patients receiving cancer treatment take an average 90 to 120 days of disability, and employers are looking for ways to help these patients return to work earlier to be fully productive, Klein said. Patients naturally seek “more peace, a longer life, and a more productive life.” Grounding treatment in evidence-based approaches and survivorship programs can begin prior to chemotherapy to meet the goals of all concerned. Holistic survivorship begins with screening and informing individuals of their cancer risk. Screening requires educating patients and their families about genetic testing and whether a cancer has a hereditary component. To gauge patients’ cancer risk, the Aetna website allows them to provide information on their family history of cancer. “Education on

the genetics of cancer is an important part of screening,” Klein informed attendees.

Aetna’s approach to wellness includes risk identification, encouraging changes in diet and exercise, self-directed online virtual care, and 24-hour nurse support. “If you have cancer and you understand you need to keep taking a daily walk, you need to keep eating well, you can’t pick up smoking again, you are going to come out better on the other end,” Klein said. Physicians invariably believe they are using evidence-based treatment, but Klein cited data from an internal Aetna study that found this was true just 62% of the time, The percentage increased to 87% in a pilot program within Aetna that provided doctors with a clinical decision support system, based on guidelines from the National Comprehensive Cancer Network and the American Society of Clinical Oncology.

A study centered on patients with non-small cell lung cancer found that providers following guidelines and documenting their treatment reduced costs up to 35%. “The value equation is, ‘What can you do to improve the quality and reduce the cost?’ We’ve seen in studies you can reduce costs and have the same or better outcomes,” Klein said. The insurer is paying physicians for preparation of care summaries. “A lot of patient information” is an important aspect of evidence-based treatment to improve outcomes. “This is important because if the patient has a chaotic journey through their cancer treatment, they are not set up for good survivorship care,” he said.

Effective case management is acutely important at diagnosis and discharge, the crucial transitions for patients. Navigators are important for guiding the patient through bewildering and often frightening treatments, and the practical considerations of undergoing chemotherapy. Aetna has programs to begin case management prior to chemotherapy, a time when navigators play an important role in helping patients with practical matters and setting the stage for survivorship. The conclusion of treatment is a key juncture, particularly for patients requiring palliative care that is “still applied extremely unsystematically,” Klein said. “Any time you see something that is not applied systematically and is all over the place, you can guess there are not best practices and efficiency applied.”

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