Cost Implications of Oncology Care for the Patient

Alan Balch, PhD: We serve about 25,000 patients a year through our case management program. These patients present to us with a number of different problems. We perform an open-ended intake assessment—we call it the emergency room for affordability and access.

The number-one thing that patients ask for assistance with is [their] co-pay for doctors’ visits and hospital bills. The second thing is transportation. The third thing is co-pay assistance for pharmaceuticals. The fourth is utilities, and the fifth is rent—and there’s a reason for that; I alluded to it before. They’re making trade-offs between affording their insurance care, and their medical care, and their ability to afford their everyday care. Those things bundle at the top. There’s really not any statistical differences between those. That’s just the order of them—but they all fall within a range where that’s sort of the bundle of things that patients, at least the low-income patients that we’re helping, are presenting to us with.

And so, going back to your conversation about cost, I think in these patients in our surveys, about half the time they are trying to understand what the cost implications of their care are before they start care. Many of them are already seeking that cost—what is the cost burden going to be? I think the patients think about the same things as oncologists and healthcare providers [do]. You know, “What is my chance of survival?” Then, “What are my chances of being progression-free, controlling the tumor?” And they also think about the side effects. I think they’d love to have that conversation, which many of them will—but not everybody. “Tell me the options. What are the different trade-offs between them?”

I also think that patients, at least based on what we see, particularly low-income patients, are willing to make pretty significant trade-offs in their lives in order to pursue a treatment regimen that either their provider has told them is the best option for them or, even better, [for which] they understand what the risks and benefits are, and they know what the financial risk is, and they’re willing to take it. I think that’s what concerns me about some of this—making decisions beforehand about what a patient can or cannot afford and either limiting choices or directing them in certain ways based on some presuppositions. Rather than how to have that cost conversation, when to have it, and how to do it in a productive way with patients. It is important.

Ted Okon, MBA: I’m glad you said that and put it in perspective, and I’m going to keep coming back to this over and over again. Look, the drug piece is something that has to be solved. I have talked to the leadership, as Ira knows, at Janssen. I’ve talked to the leadership of Lilly, and I’ve said to all of the companies, “The drug price is an issue; it has to be addressed.” But we have to put in perspective that even though we come back to the drug piece all the time, there is a big other world out there.

Eighty percent of the pie chart is other costs associated with cancer care. Then, there’s the third dimension of where that care is delivered, because there are differences when it’s in community oncology, an independent practice, or when it’s at the hospital and a large health system site.

So, I’m glad you said Alan that patients are calling in not just saying, “How do I get my drug co-pay?” but, “How do I get my hospital co-pay?” “How do I get my co-pay associated with my physician’s visit, or radiology, or radiation, or any other aspect of it?” We’ve got to be clear about that, because I can tell you right now, and I say it with 2 representatives from drug companies here—it’s a problem.