Los Angeles, CA—A new patient incentive program aligns patient behaviors and choices with financial incentives in an effort to reduce the financial burden of cancer care for patients. The program was introduced to attendees at the Fourth Annual Conference of the Association for Value-Based Cancer Care by Gordon Kuntz, Senior Director of Payer Solutions at ION Solutions.
Patients with cancer represent an average of well under 1% of patients in a health plan yet account for 10% to 15% of the plan’s costs, creating management challenges, said Mr Kuntz. The average cost of care in the 6 months after the first round of chemotherapy is approximately $125,000. “That’s a big deal for the payers, but for members, it’s a bigger deal,” he said.
Patients with cancer earning ≤$60,000 (the average annual income in the United States is $51,000) can expect to spend 25% of their annual gross pay on health-related issues in the year they are diagnosed. Patient payment responsibility has been increasing by 5% to 6% annually.
Although copays may encourage higher member financial responsibility and more rational decision-making in healthcare purchasing, “when you have cancer, there’s not a lot of discretion involved in your treatment,” said Mr Kuntz. “There’s not a lot of shopping involved. There are not a lot of comparisons to be done.”
This creates an imbalance in which some patients will have to make choices that no one should have to make, he said, creating significant financial stress.
Other major unintended consequences of increased patient financial responsibility are treatment avoidance and reduced adherence, which can paradoxically increase the cost of treatment for the payer as the disease progresses and becomes more costly to treat.
“We look at this as an opportunity for change,” said Mr Kuntz. In an initiative that began at ION Solutions, payers and self-funded employers reward patients with cancer for program compliance. The goal is to reduce health plan costs, including those related to oral drug waste, emergency department utilization, and unwanted services, while maintaining cancer care quality and patient satisfaction.
“Patients will respond to financial incentives for steerage in oncology, physician selection, and program compliance,” Mr Kuntz said.
Once a patient is identified in the practice, a list of behaviors expected of the patient is generated, with a list of “triggers.” The triggers range from behaviors expected at the initial diagnosis through therapy (Table). Examples of triggers include completing disease-specific education and having a caregiver present at the training, participating in distress screening, and discussing a written treatment plan.
As the patient completes the triggers related to cancer treatment, he or she receives monetary credit. The credit is applied to a credit card that can be used for any healthcare expense, including copays. ION reports to the employer or the health plan how the patient’s participation in this activity contributed to lower cost for that patient, as well as the employer or the health plan.
“We’re not saying that patients shouldn’t go to the emergency department. If you need to go to the emergency department, you need to go to the emergency department,” Mr Kuntz said. “But you need to communicate with your oncologist and the office before you do. You need to make sure that you’re calling the office for support along the way.”
This program results in an alignment of stakeholders to provide superior cancer care. “The patient is the beneficiary, but also an integral part of that alignment,” said Mr Kuntz.