The Need for Payer Support in Overcoming Cancer Care Disparities

During an Institute for Value-Based Medicine event in November 2024, experts in oncology highlighted how insurance coverage disparities and financial burdens limit equitable cancer care. In this interview, Susan Escudier, MD, FACP, medical oncologist and vice president of value-based care and quality programs at Texas Oncology, explains how oncology benefit design should evolve to better support patients facing social determinants of health (SDOH) barriers.

Transcript

How can oncology benefit design be evolved to better address the challenges posed by SDOH?

You know, it's huge, one of which is [that] I will admit that I think we need better access to health care. I think that we have a huge uninsured problem in Texas. Texas is one of the few states that hasn't expanded Medicaid, and so it's very difficult. There [is] very irregular access to health care [and] public health depending on what county you're in. If you're in Harris County, for example, we have a great public health system, we have great cancer care that's coordinated by Baylor College of Medicine and MD Anderson; similar stuff in Austin and San Antonio. Not so much if you're from a small county somewhere. So I think that is a huge problem.

In terms of payers, I think that they really have to take into account things like helping patients with transportation costs. I mean, some people, if they have to take a day off of work, pay for gas, pay for parking, they're going to have trouble feeding their kids that weekend. And so I think that the payers, whether they're government or private payers, need to understand what hardship patients go through just to get to us to get their treatment. Now, of course, that is one of the benefits of having a broad network like we do, so that patients don't have to drive into the big city to get their care.

I also think that care management is more important in people with a high number of social determinants of health that are high risk. People, for example, with housing insecurity, food insecurity, those people, they just need more help. They need help understanding what's going on, what they need to do. We have patients who don't even have a smartphone or a computer, so they don't know how to access systems. I think those people just require a different type of outreach from us, and I think that the payers need to be able to take that into account so they can help us with that.