Oncology innovations and cancer care treatment are complex, exceeding an estimated $200 billion in 2020. As cancer research constantly develops new treatments and data, payers and providers are learning valuable lessons about improving care delivery. Cancer care involves orchestrating a robust support system and establishing an important and collaborative relationship between all involved: the provider, the payer, and the patient.[1]
It’s always difficult to pivot from diagnosis to treatment. The patient, and their family, are faced with absorbing a serious diagnosis while also having to endorse a treatment path forward. Treatments should be applicable and accessible to everyone, scaled to align with best practices and consistent—supporting value-based care, and always based on the best available science.
With Rising Costs, Data Enables Effective Strategies and Lowers Oncology Treatment Spending
Treatment of cancer patients has an enormous impact on the entire healthcare economic ecosystem because of the costs involved in treatment. Oncology-related healthcare spending is expected to reach $246 billion by 2030, ballooning as baby boomers age and are increasingly diagnosed with cancer. And even without the boomer effect, data suggests that in the United States, between $75 billion and $101 billion is wasted on overtreatment or low-value cancer treatments each year.[2][3]
Moreover, a recent study published by JAMA Internal Medicine found that over a six-month span, U.S. hospitals increased the price of cancer therapies for patients with private health insurance, in some cases, more than seven times. As costs rise, early interventions, precision in diagnosis, and evidence-based treatment are key to optimizing outcomes and containing costs that continue to skyrocket.[4]
While searching for cost-savings measures is important, patients, providers, and payers cannot compromise on their expectations for comprehensive, evidence-based guidance for the treatment of complex diseases. Today leveraging advanced technology to decipher treatment options—or validate approaches– offers providers and payers another resource for delivering on their missions more quickly, precisely, and effectively, thus creating savings along the continuum.
One way to support this is via an advanced research library platform that enables cancer treatment authorization and ensures the prescription of high-quality, high-value care that rapidly aligns treatment to providers and payers. Today, increasingly sophisticated evidence-based decision support and treatment validation platforms can rapidly connect providers and payers to the treatments and protocols that quickly deliver effective, high-value care and provide peace of mind at the moment of prescription.
In some cases, clinicians can view thousands of evidence-based treatment regimens, federally registered clinical trials, levels of evidence, expected clinical outcomes, and treatment costs all before selecting a course for their patients. More importantly, these tools align the interests of all the parties involved before treatment begins, leading to value-based care and avoiding bottlenecks for the patient and wasting precious time.
Creating Consistency in Care
A shared center of evidence-based insights and data also enables new levels of consistency. Today, a cancer patient’s treatment is too often determined by the circumstance of their diagnosis versus uniform decision-making with evidence-based data and findings. Within the same expanded practice, it’s not uncommon to encounter varying approaches to treatment. With the number of perspectives and the ever-growing tide of new data involved in cancer research and treatment, no single provider could be able to decipher all the paths.
Providers can eliminate unnecessary variability in care by applying nationally accepted treatment standards during their clinical prescription. Then, the automated process reduces the administrative burdens of obtaining and providing authorizations and ensures appropriate reimbursement at the regimen level, aligning payers and physicians in the best interests of patients while limiting appeals and denials.[5]
Choosing the most effective, value-based treatment is also everyone’s goal when treating cancer. It is the first, most important step forward, and the treatment discussion can provide the foundation for therapeutic collaboration. If done correctly, the treatment discussion with patients begins an ongoing conversation in which all participants hear, understand, and trust one another.
Access to data and shared decision-making is a known organizing principle to inform patients, increase decision satisfaction and improve patient-doctor communication. When the patient grasps the arguments for and against treatment and understands they can choose, questions are asked aloud, tradeoffs are examined, and conversations, not medical lectures, occur.
The Value Proposition
Clinical decision support and treatment validation platforms automate the transfer of health plan and patient clinical data and care information, benefitting all the stakeholders in the healthcare ecosystem and having the ability to dramatically increase consistency of care.
For Plans
Healthcare plans can transform from organizations traditionally viewed as gatekeepers to active participants in improving the quality of care. In addition to dramatically increasing process efficiencies, healthcare plans can implement technologies that enable authorization for appropriate, evidence-based care for the patient, which in turn manages costs while driving positive outcomes.
For Physicians and Caregivers
Providers can use the clinical knowledge they have on the patient to review optimal treatment options based on scientific evidence and aligned with payer policies, helping them make informed care decisions with the patient.
For Patients
When healthcare plans and providers align on high-quality, high-value care, patients benefit from peace of mind that their care plan meets both evidence-based standards and reimbursement requirements.
Reduced Costs and Errors
In the United States, the average cost of unwarranted care per patient is $25,579. Ensuring the most appropriate treatment is prescribed for every patient upfront can reduce unnecessary spending on unneeded, inappropriate care.
The goal is to increase the quality of care, focus on preventative maintenance, and promote healthy choices to lower healthcare costs over the long term. Healthcare providers can simplify their patients’care by analyzing historical data and eliminating unnecessary tests and procedures. Instruction to patients about potential treatment pitfalls can quickly yield benefits: eliminating just a single overnight hospital stay over a patient’s lifetime can result in significant savings while decreasing the stress on patients.
Preventing medically related errors, scenarios every provider and their patients want to avoid. More importantly, improves outcomes. Healthcare providers and insurers allocate significant resources to identify, understand and reduce medical errors. Standard procedures and checklists can reduce oversights leading to errors. Improved platforms and programs can provide timely information to prevent medical errors and rewards for healthcare providers who reduce them. Care quality and outcomes improve while costs decrease.
Improving the outcomes of cancer patients requires multi-factor approaches across the continuum of care. However, it will never be enough for researchers to advance treatments and bring new drugs or procedures to market. There also must be scalable continuity and accessibility to evidence-based approaches. Additionally, factors including expediting diagnosis and treatment, rallying behind patients promptly with evidence-based treatments, and the ability to reassess as conditions shift are all important to advancing outcomes.
Consistent, evidence-based care aligns payers, providers, and patient outcomes. Early diagnosis and personalized treatment lead to better results—and technology has a pivotal role to play for each patient.
Reference
[1] Financial Burden of Cancer Care. Trends in US Cancer Control Measures. National Cancer Institute. Online. Last accessed on May, 10, 2022.
[2] The Cost of Cancer, edition 2020. Cancer Action Network. Online. Last accessed May 10, 2022.
[3] Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:10.1001/jama.2019.13978 Online. Last accessed on May 10, 2022.
[4] Xiao R, Ross JS, Gross CP, et al. Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance. JAMA Intern Med. Published online April 18, 2022. doi:10.1001/jamainternmed.2022.1022. Online. Last accessed on May 10, 2022.
[5] Treatment Validation Options for Hospitals and Health Systems. NantHealth. Online. last accesses on May 10, 2022.
[6] Study Identifies Billions of Dollars in Potential Savings by Eliminating Unwarranted, Non-Evidence-Based Cancer Treatment. BusinessWire. Online. Last accesses on May 10, 2022.
Featured image: Binary code, data stream. Photo courtesy: © 2016 – 2022 Fotolia/Adobe. Used with permission.
