How could nationwide value-based payment for cancer care become a reality in the next 5 to 10 years? Looking to today’s market for clues, our team has envisioned three scenarios of how stakeholders could make this happen.
In each scenario, we describe what the future would look like, how it would unfold, and what it would mean for major stakeholders in healthcare — and what to do if this future doesn’t look rosy for your organization.
Continued growth in cancer spending would push employers to steer employees to high-value cancer providers. Self-funded employers would work with third party vendors to identify and contract with low-cost, high-quality cancer providers in their markets, especially those already engaged in value-based care initiatives. Fully insured employers would then follow suit, urging health plans to use incentives to navigate members to high-value cancer providers.
Self-funded employers have the flexibility to drive this strategy as part of their benefit design. Rising price transparency, a growing awareness of site-of-care cost differentials, and increasing employee openness to lower-cost cancer care options are already providing the motivation to do so.
As a result, competition between cancer providers would grow and the total cost of cancer care would decrease. This would play out at the market level
Managing cancer costs is becoming top-of-mind for employers, as cancer is now the top driver of employer healthcare costs, surpassing musculoskeletal conditions. Though employers have traditionally been hesitant to put restrictions around cancer coverage, a lack of meaningful cost control levers and the pressure of skyrocketing prices is making them more open to steering employees to specific facilities or centers of excellence that will provide efficient and high-quality care.
Employer steerage to high-value cancer providers is becoming more feasible, as several companies have launched products in the last few years to help employers with this type of navigation. Each of these organizations has grown rapidly since launching, demonstrating employer appetite for these types of solutions.
This trend coincides with rising employer interest in “soft steerage,” in which employees are incentivized to visit preferred providers or settings, while other options remain in-network. Soft steerage presents a more palatable solution to cost reduction than mandatory steerage or narrow provider networks, which limit employee choice. Employers that have already been exploring soft steerage have found that employees with cancer, instead of feeling limited, are eager to be presented with provider options that are less financially burdensome.
At the same time, the rise of remote second opinions and expert review services means patients can have access to subspecialist knowledge even while being treated in lower-cost community settings. Hundreds of employers, covering millions of employees, are already offering these types of services, making it possible to narrow cancer provider networks without limiting employee access to the latest innovations and expertise.
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