In recent years, various sources including SunLife and the Business Group on Health have reported that cancer leads high-cost health claims for self-funded plans. Claims data shows the top three diagnoses currently driving claims are cancer, cardiovascular and musculoskeletal diseases.

It’s no surprise to anyone working with employer health plans that finding solutions to the rising costs for these and other high-cost conditions has huge implications for plan sponsors and employers. Mercer’s 2023 National Survey of Employer-Sponsored Health Plans reports that cost management of high-cost claims was “rated important or very important by 84% of large employers.”

In an International Foundation webcast, “Oncology Offerings—Designing the Best Possible Benefit,” speaker Adam Bradley, co-founder of the Cancer Study Group in Washington, D.C., reviewed cancer’s impact on all plans and highlighted several statistics targeting Taft-Hartley plans, including:

  • Over 60,000 active union members are diagnosed with cancer each year.
  • The union workforce has a higher cancer incidence in general, including substantial occupational cancer risks.

One concerning statistic for plans is that cancer is being diagnosed more frequently in members under 55 years of age. Although there is not a definitive reason, some have suggested it could be due, in part, to lower recommended screening ages in recent years. For example, screening colonoscopies are now recommended at age 45 instead of 50.

During the webcast, Bradley extensively outlined three primary levers plan sponsors may use to impact cancer patients and their navigation of the health care system, while also helping plans manage costs.

  • Catch cancer early for better outcomes.
  • Help participants reach the proper care right away, as the first month after diagnosis is crucial.
  • Manage prescription drug usage, since drug costs are increasing and can be more expensive depending on delivery location.

The webcast’s second speaker was William Feyling, administrator at Carpenter Funds Administrative Office of Northern California, Inc. He provided a comprehensive case study on the fund’s project to implement an oncology navigation benefit. Feyling described how the fund gained an understanding of how cancer was affecting its over 75,000 covered lives.

He further highlighted the following advantages of the navigation benefit:

  • Improved participant experience for compassionate cancer care
  • Availability of technology and analysis of claims data for assistance with controlling costs
  • Better outcomes for patients and improved management of specialty drug costs.

After the case study, the webcast Q&A section featured questions that addressed the mental health aspect of cancer treatment, risks related to the occupation and age of participants, and cancer treatment locations, among others.

To learn more about oncology offerings for your plan, view the entire webcast recording, “Oncology Offerings—Designing the Best Possible Benefit.”

Developed by International Foundation Information Center staff. This does not constitute legal advice. Please consult your plan professionals for legal advice.

Anne Newhouse

Information/Research Specialist at the International Foundation of Employee Benefit Plans Favorite Foundation Service: The Information Center! Members having the ability to have an information specialist research their topic is a great benefit. Favorite Foundation Moment: Attending the 2013 CEBS conferment ceremony in Boston as an official CEBS graduate. Benefits Related Topics That Interest Her Most: Benefit communication—helping employers understand what employees want and the way they want it communicated to them. Personal Insight: Anne may spend her days in the International Foundation employee benefits library, patiently researching answers to member questions—but after work, she’s ready to move with a bike, hike or walk in the great outdoors.

Recommended Posts

Understanding ERISA Liability in the Context of Pharmacy Benefits

Anne Newhouse
 

Fiduciary responsibility has always been a concern for retirement plans governed by the Employee Retirement Income Security Act of 1974 (ERISA). The language on the Department of Labor (DOL) Fiduciary Responsibilities webpage explains, “The primary responsibility of fiduciaries is to run the […]