Finding the Ideal Set of Oncology Employer Benefits
A Carrum Health/PWC report surveys benefit managers spanning various self-insured employers in an effort to determine ways to improve the cancer treatment experience, especially from a cost perspective.
When it comes to what employers are looking for on behalf of their employees, medical benefits, including in oncology, are at the top of the list.
A “state of the market” report for 20241 authored by Carrum Health and PwC notes that by 2030, national incidence of cancer in people under the age of 50 is expected to increase by 31%, which will skyrocket the total spend to $246 billion. For further perspective, employer-based insurance plans are expected to cover half of those associated costs.
As a result, when it comes to cancer care, employees want a type of “one-stop-shop” that can not only assist members but provide financial savings as well. Value-based centers of excellence programs (COEs) are trying to fill that void, but the authors argue that they can provide the “holistic experience that employers and patients seek.”
Even so, the report offers a detailed dive into obstacles, priorities that employers have, and actions required in order to give members the value they are looking for in a plan.
With 85% of benefits managers acknowledging oncology and a top-three cost driver—and 43% rating it as the top cost driver—it is fairly consistent with a Business Group on Health 2024 survey,2 which notes that 88% see oncology as the top health specialty cost driver. When further exploring cancer care itself, many may not be surprised to learn that outpatient treatments (such as chemotherapy) and medication lead the way in terms of spend. A PwC employer survey confirmed that drugs in this space (chemo and non-chemo biologics) accounted for 56% of Medicare per patient spend. In 2020, spend on cancer drugs in the United States hit $71 billion, which is an 87% uptick from five years prior.
“Cancer is quickly becoming our highest area of cost, made worse recently due to delayed care and preventative screenings due to COVID,” a benefits manager at a biotech company explained to the report’s authors. “These experiences are very difficult for our employees. We know this is an area we want to lower costs, while providing a high-touch, white-glove service.”
The challenge lies with current benefits portfolios, which oftentimes are not very successful in addressing the entire process of cancer care. For instance, solutions for employers to pick from can lack options surrounding treatment, and when it comes to addressing cancer spend, have been unable to lower the costs.
The highest employer offering that they’d like to see from oncology solutions lies with the COEs and other value-based products, which are intended to slice cost and improve quality for its members. There are also incentives for providers that can help steer them toward finding more cost-effective therapies to offset those rising expenses, specifically with the help of care navigation solutions support members, who can find services while contacting multiple providers. There are also early screening vendors who are able to get out in front of screenings by arranging and conducting the employee screenings before conditions worsen. However, many of these COE-type solutions fail to be included in portfolios, using multiples vendors that are only prioritizing one pain point. In other words, employers are electing to proceed with the narrower, easy-to-implement option, while neglecting the holistic approach.
PwC reiterated the need to act fast to address these needs, concluding that “while the market is still nascent, we expect both independent solutions and large insurance providers/TPAs to move toward offering COE programs to manage oncology. Employers looking to take bold action to meaningfully reduce costs can work now to evaluate and implement COE programs for their benefit portfolios.”
References
1. Ahlquist G, Chandra A, Craig K, Wij I. Oncology employer benefits and centers of excellence solutions: State of the market 2024. Carrum Health, PwC. February 2024. https://carrumhealth.com/blog/resource/the-state-of-oncology-benefits/
2. Business Group on Health. (2024). 2024 Large Employer Health Care Strategy Survey: Executive Summary. Retrieved from https://www.businessgrouphealth.org/resources/2024-large-employer-health-care-strategy-survey-executive-summary
