Latest / Becker’s Payer Issues Podcast / Closing the Cancer Care Gap: How Integrated Screening and Treatment Support Improve Outcomes

Transcript

Closing the Cancer Care Gap: How Integrated Screening and Treatment Support Improve Outcomes · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:04
  the Becker's Healthcare podcast series. It's great to
• 0:06
  have you. Today, we're talking about closing the
• 0:09
  cancer care gap, how integrated screening and treatment
• 0:12
  support improve
• 0:14
  outcomes. And joining me for today's discussion, I'm
• 0:16
  so excited to have her as Alexandra Anderson.
• 0:18
  She's the head of health plan sales and
• 0:20
  partnerships at Kala. Alexandra, thanks so much for
• 0:22
  being here today and taking some time. It's
• 0:23
  great to have you. Thanks for having me,
• 0:26
  Lucas. It's a pleasure to meet you virtually.
• 0:28
  Absolutely. For those that might not know you
• 0:31
  yet, at least, if you could just introduce
• 0:33
  yourself and share a little bit about your
• 0:35
  work in in the health care space.
• 0:37
  Yeah. Absolutely. I lead all, to your point,
• 0:40
  all of Color sales and partnership efforts with
• 0:42
  health plans,
• 0:43
  pharmacy benefit managers, and TPAs to fundamentally
• 0:47
  rethink how we approach cancer detection and care
• 0:50
  throughout the entire cancer care continuum from
• 0:53
  screening and early detection through improved
• 0:56
  active treatment management
• 0:58
  into survivorship mitigating the risks of cancer reoccurrence.
• 1:02
  My background personally
• 1:04
  has always been centered around improving access and
• 1:06
  outcomes in health care, particularly in areas where
• 1:09
  there's a disconnect between what's clinically possible
• 1:12
  and what actually happens in the real world,
• 1:14
  and cancer is one of those clearest
• 1:17
  examples of that gap.
• 1:19
  In The US, we have well established screening
• 1:22
  guidelines and strong evidence that early detection does,
• 1:25
  in fact, dramatically improve outcomes and lower costs.
• 1:29
  But all too often, those guidelines aren't consistently
• 1:31
  applied or patients fall through the cracks entirely.
• 1:34
  And at Color,
• 1:35
  we are focused on closing that gap. So,
• 1:39
  we operate as a cancer specialized
• 1:41
  oncologist
• 1:42
  led model
• 1:43
  that works alongside health plans and their existing
• 1:46
  network infrastructure. So our role is really to
• 1:48
  bring precision
• 1:49
  into cancer care starting with identifying who is
• 1:52
  truly at risk for cancer,
• 1:55
  ensuring they're screened,
• 1:57
  concordant with guidelines,
• 1:59
  and
• 2:00
  then actively managing what happens next, especially when
• 2:03
  there's an abnormality
• 2:04
  detected. And what makes this work particularly meaningful
• 2:07
  is that we're not increasing screening volume. We're
• 2:10
  helping to ensure the right people are getting
• 2:13
  the right care
• 2:15
  at the right time based on guidelines.
• 2:17
  And that includes individuals who might not show
• 2:19
  up in traditional claims based models,
• 2:22
  people
• 2:23
  without recent health care utilization
• 2:26
  or claims history or those whose family history
• 2:29
  or risk factors
• 2:30
  aren't fully captured in the system or understood
• 2:33
  elsewhere. And so, ultimately, the goal is to
• 2:35
  create a more coordinated,
• 2:37
  proactive approach for members and participants
• 2:39
  while helping
• 2:41
  payers and health plans improve outcomes and better
• 2:43
  manage one of their most significant cost drivers.
• 2:47
  And I wanna take a step back here
• 2:49
  and touch on a couple of things that
• 2:50
  you've just mentioned there in your intro, which
• 2:52
  are certainly critical. Again, you talked about preventative
• 2:55
  screenings and the importance of them. Right? And
• 2:56
  we know that cancers found through preventative screening
• 2:59
  are more likely to be caught at stage
• 3:01
  one at a much lower cost
• 3:04
  than later stage diagnosis as as you mentioned.
• 3:07
  With that in mind,
• 3:09
  how would you describe the current cancer screening
• 3:12
  landscape that we're in both for payers and
• 3:15
  members,
• 3:16
  and what are some of those key challenges
• 3:18
  and opportunities
• 3:19
  that you're seeing?
• 3:21
  Yeah.
• 3:22
  The current landscape is really at an interesting
• 3:24
  inflection point from mark from a pure market
• 3:27
  perspective, and I think the conversation is finally
• 3:29
  catching up to the data that has been
• 3:31
  in front of us for admittedly a while.
• 3:35
  On one hand, there's strong awareness both clinically
• 3:38
  and economically
• 3:39
  of the value of preventative screenings.
• 3:41
  Data consistently
• 3:43
  shows that cancers detected through routine screenings are
• 3:46
  far more likely to be diagnosed at an
• 3:48
  early stage,
• 3:49
  oftentimes stage one, where treatment is not only
• 3:52
  more effective, but significantly
• 3:55
  less costly to treat.
• 3:57
  There is now strong validation from independent research
• 4:00
  that preventative screenings are one of the best
• 4:03
  investments a health plan can make. So
• 4:05
  a recent Blue Cross Blue Shield Association and
• 4:08
  Blue Health Intelligence study examined claims data for
• 4:11
  members diagnosed with breast or colorectal cancer
• 4:14
  and found that those identified through preventative screenings
• 4:17
  were dramatically
• 4:18
  more likely to be caught at an early
• 4:20
  stage.
• 4:21
  For colorectal cancer, eighty one percent of members
• 4:24
  diagnosed through preventative screen were classified at an
• 4:27
  early stage
• 4:28
  compared to seventy three percent overall.
• 4:30
  For breast cancer,
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  it was around eighty six percent through preventative
• 4:35
  screenings versus eighty two percent overall. And that
• 4:38
  may sound like a modest difference in percentages,
• 4:40
  but the cost and survival implications of that
• 4:43
  are enormous.
• 4:45
  The same research quantified that one of the
• 4:48
  things that we have long understood directionally,
• 4:51
  which is that breast cancer treatment averages roughly
• 4:54
  eighty three thousand dollars at stage one detection
• 4:57
  versus
• 4:58
  over a quarter of $1,000,000
• 5:01
  at stage four.
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  For colon cancer specifically, those numbers jump up
• 5:06
  from
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  a $110,000
• 5:09
  to over a quarter of $1,000,000
• 5:10
  for stage one versus stage four comparison.
• 5:13
  And the downstream cost impact is sustained.
• 5:16
  Per member, per month health care costs were
• 5:18
  nearly 10% lower over ninety days and more
• 5:21
  than 20%
• 5:22
  lower over one year for breast cancer patients
• 5:25
  diagnosed, again, through preventative screening measures. For colorectal
• 5:29
  cancer, costs were down more than 23%
• 5:32
  over 90 and 33%
• 5:34
  over the full year.
• 5:36
  So these aren't marginal gains we're talking about.
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  They're structural
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  total cost of care reduction
• 5:42
  driven by catching this disease earlier.
• 5:45
  So the case for preventative screening
• 5:48
  in my mind is airtight. The the challenge
• 5:50
  is then execution, and that's where the landscape,
• 5:54
  at least the current landscape,
• 5:55
  remains fragmented. I always like to say,
• 5:58
  there is no cure for cancer as we
• 6:00
  know it today. Right? All data and studies
• 6:03
  show that cancer is affecting a wider swath
• 6:05
  of the population. It's also unfortunately trending younger
• 6:08
  in age.
• 6:10
  So it would behoove us to detect early
• 6:12
  versus
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  detect late when cost of care is significantly
• 6:16
  lower,
• 6:17
  and individuals have the best chance at survival
• 6:20
  outcomes.
• 6:22
  But
• 6:23
  most health plans have programs in place today
• 6:25
  to identify members who are due for screening
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  typically built on ace age based triggers
• 6:31
  and retrospective claims data. So for average risk
• 6:34
  populations,
• 6:35
  that approach works reasonably well, but it systemically
• 6:38
  misses a critical segment of the population, which
• 6:41
  is individuals whose personal history,
• 6:44
  family history, or genetic factors place them at
• 6:47
  elevated risk and to who by guidelines criteria
• 6:50
  should be screened earlier or more frequently.
• 6:53
  These individuals exist in every large population and
• 6:57
  traditional outreach models
• 6:59
  and screening programs are does not designed to
• 7:01
  find them.
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  There is also,
• 7:04
  to keep going,
• 7:06
  certainly a behavioral component.
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  Even when members are identified as due for
• 7:10
  screening or have a screening gap identified,
• 7:13
  adherence is inconsistent. Barriers like access, awareness, or
• 7:17
  simply competing priorities can delay or prevent screening
• 7:20
  completion.
• 7:21
  I'm sure you all know, I certainly do,
• 7:23
  someone that is due for a colonoscopy
• 7:26
  that hasn't made time to get one scheduled.
• 7:29
  Maybe they would complete a fit test. But
• 7:31
  from what we've seen across COLOR's populations,
• 7:34
  over half of screening eligible members are not
• 7:37
  up to date on at least one recommended
• 7:39
  screening.
• 7:40
  Among individuals we identify elevated risk,
• 7:43
  seventy three percent were not adherent to recommended
• 7:46
  screenings at the time that they entered and
• 7:48
  enrolled in COLOR's program.
• 7:50
  That's a, like, staggeringly
• 7:52
  large percentage of the population
• 7:54
  who were already at elevated risk, and they're
• 7:56
  still not receiving appropriate care.
• 7:59
  So the opportunity here is to move decisively
• 8:02
  beyond a one size fits all approach and
• 8:04
  model
• 8:05
  that's retrospective
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  and towards a more precise proactive model, which
• 8:10
  means identifying
• 8:12
  risk at the individual level,
• 8:15
  not just by age,
• 8:17
  aligning screening recommendations with established guidelines that are
• 8:20
  set forth by USPSTF,
• 8:23
  ACS, and NCCN,
• 8:24
  and most importantly, ensuring that screening is just
• 8:27
  the beginning of care of the care journey
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  where members need oncologist led care through an
• 8:34
  abnormality being detected into diagnosis and treatment initiation
• 8:38
  as well as survivorship. So delivering proactive, timely
• 8:42
  clinical interventions
• 8:43
  spanning the cancer care continuum
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  as a means to mitigate, you know, disastrous
• 8:48
  outcomes for lack of a better term. When
• 8:51
  those pieces come together, you start to see
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  meaningful improvements, not just in screening rates, but
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  in earlier detection as well, which translates to
• 8:58
  better outcomes and measurable reductions
• 9:01
  in total cost of care. And color's role
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  is really to make that level of precision
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  and follow through scalable across large populations.
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  And the reason why I was letting you
• 9:11
  finish there was because you very eloquently described
• 9:15
  the integration part of this and why the
• 9:17
  integration of all of this is so important
• 9:19
  into cancer care programs to be able to
• 9:21
  identify members earlier and have that proactive approach
• 9:25
  that you've just outlined to be able to
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  identify them early, lead through those screenings, and
• 9:29
  then help them
• 9:31
  get the outcomes that they're looking for, which
• 9:33
  is so crucial. I do wanna touch a
• 9:35
  little bit more on, a piece that's very,
• 9:37
  very important. I think especially today, which is
• 9:40
  the home cancer screening kit piece of all
• 9:43
  of this. Right? It's a convenient option for
• 9:45
  members to make this process easier as you've
• 9:47
  just touched on. That's an important part is
• 9:49
  making things easier for people.
• 9:51
  Again, there is still a lot of questions,
• 9:53
  however, on completion and return rates and are
• 9:55
  people actually doing the right thing.
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  What are you seeing there in member follow
• 9:59
  through? And, again, if you can touch on
• 10:01
  the role that color plays in
• 10:04
  closing that gap there from a usability
• 10:07
  perspective.
• 10:08
  Absolutely.
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  And I get this question all the time.
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  So
• 10:12
  risk identification,
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  to your point, is the foundation of everything,
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  and it's also one of the biggest gaps
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  that exist between what traditional programs can do
• 10:20
  and what oncologist led clinically integrated and cancer
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  specialized models can do. While most programs today
• 10:27
  rely heavily on claims data, claims are useful,
• 10:30
  but they're not fundamentally
• 10:32
  retrospective. They tell you what's already happened. They
• 10:34
  don't capture the key inputs that actually drive
• 10:36
  cancer risk, whether it's detailed family history, genetic
• 10:39
  predisposition,
• 10:40
  prior abnormal findings that may have not generated
• 10:41
  a coded claim, for example, to appear in
• 10:41
  claims history.
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  Coded claim, for example, to appear in claims
• 10:47
  history, or whether it's lifestyle and environmental factors
• 10:50
  or clinical nuances that require an oncology expertise
• 10:53
  to properly
• 10:55
  interpret what that means from a risk perspective.
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  We've seen as high as twenty five percent
• 11:02
  of the members we engage having no claims
• 11:05
  activity in the eighteen months prior to enrollment.
• 11:09
  Twenty three percent of all color participants across
• 11:12
  our book of business are due for one
• 11:14
  or more screenings when we engage them. So
• 11:16
  that's a large number of folks, again, falling
• 11:18
  through the traditional cracks of the system.
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  So what does that mean from, like, a
• 11:22
  percentage perspective? One in four color participants are
• 11:25
  due for one or more screenings when we
• 11:26
  engage them.
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  Color closes
• 11:30
  seventy seven percent and even higher
• 11:32
  screening gaps identified, all working within the construct
• 11:36
  of the member's medical coverage. For our at
• 11:38
  home screening specifically,
• 11:41
  we see return rates as high as sixty
• 11:44
  to eighty percent
• 11:46
  across our book of business for each one
• 11:48
  of those individualized screenings.
• 11:50
  And a lot of it is in the
• 11:51
  direct member communication. The very first thing that
• 11:54
  we do when we interact with a member
• 11:57
  who wants to better understand their risk for
• 11:59
  cancer is educate them. Educate them on why
• 12:03
  they are due for screening, what this means
• 12:05
  for them personally. They personally
• 12:08
  elect to be referred for an in person
• 12:10
  mammogram,
• 12:11
  or they personally elect
• 12:13
  to complete an at home colorectal cancer screening.
• 12:17
  It's not just showing up at their, you
• 12:19
  know, in their mailbox within without any four,
• 12:23
  or prior communication
• 12:24
  from color. They've already had a conversation helping
• 12:27
  them to educate,
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  you know, and that's really our goal is
• 12:31
  to not only close the screening gap, but
• 12:33
  educate folks about their risk. And that's one
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  of the reasons why we see such high
• 12:36
  screening gap completion rates.
• 12:39
  You mentioned two important aspects here, which is,
• 12:41
  again, just touching back on what we've talked
• 12:43
  about, which is integration usability, but you've also
• 12:46
  mentioned education, which is crucial for people to
• 12:48
  understand how is this actually working, how is
• 12:49
  it going to benefit me. It's very, very
• 12:51
  important.
• 12:52
  When you're looking at the engagement piece from
• 12:55
  a from a macro perspective, right, what's that
• 12:58
  one step that you want organizations to take,
• 13:01
  right, to move in that direction
• 13:03
  where they can improve
• 13:05
  engagement,
• 13:06
  and and what does that look like, right,
• 13:08
  in a in a well designed cancer screening
• 13:10
  program?
• 13:11
  Lucas, this is one that I'm personally very
• 13:13
  passionate about. So if you hear some passion
• 13:16
  in my voice, know that that's
• 13:18
  that's the background.
• 13:19
  So in a well designed program, engagement is
• 13:22
  not just a singular event. It's engagement across
• 13:26
  a full continuum. Right? And that's a fundamentally
• 13:28
  different way of thinking about it than most
• 13:31
  programs that are currently structured around just enrollment
• 13:34
  rates. Right? The conventional model treats engagement as
• 13:37
  a moment, initial engagement with the member, and
• 13:39
  then the member does a screening, the completion
• 13:41
  is recorded, and that interaction closes. But cancer
• 13:44
  prevention
• 13:45
  and preventative care broadly
• 13:47
  does not work that way. Risk is not
• 13:49
  static. Screening needs evolve as someone ages or
• 13:52
  as new evidence
• 13:54
  updates.
• 13:55
  Guidelines change on an ongoing basis all the
• 13:58
  time for each individual cancer type, and if
• 14:00
  something is found,
• 14:02
  the engagement that follows that abnormal
• 14:05
  being detected as part of the screening
• 14:08
  is often most consequential part of the entire
• 14:11
  journey. So a well designed program is built
• 14:13
  for continuity across the full continuum from risk
• 14:17
  assessment through screening gap closure, through any clinically
• 14:20
  appropriate diagnostic follow-up, and if needed, into treatment
• 14:25
  navigation and survivorship.
• 14:27
  That means the program has to be personalized
• 14:29
  based on individual risk,
• 14:31
  not just demographic eligibility.
• 14:34
  It has to be clinically grounded, aligned with
• 14:37
  the guidelines that are well established as we've
• 14:39
  talked about previously
• 14:40
  so that the actions we're driving are right
• 14:44
  and clinically appropriate for each member. It has
• 14:46
  to be proactive with clear accountability for what
• 14:49
  happens at each step so that no one
• 14:50
  falls through the cracks in that critical moment.
• 14:53
  Right? One misstep, one gap in engagement is
• 14:56
  where things go wrong.
• 14:58
  The programs that achieve strong sustained engagement also
• 15:01
  invest meaningfully in the member experience. So cancer
• 15:04
  screening can be stressful as we all know.
• 15:06
  It's confusing. It's overwhelming,
• 15:08
  particularly
• 15:09
  when what results are abnormal and a member
• 15:12
  is suddenly navigating
• 15:13
  specialist referrals,
• 15:15
  imaging appointments, prior authorization without clear guidance. What
• 15:18
  is my member cost share? Is this covered?
• 15:22
  Where do I go? Am I going to
• 15:23
  the right person, the right place?
• 15:25
  But when we design for that experience, when
• 15:27
  we make sure that every step feels connected,
• 15:31
  supported,
• 15:33
  purposeful, and thoughtful, we build trust that sustains
• 15:36
  engagement over time. That matters because prevention is
• 15:39
  not a one time transaction. It's an ongoing
• 15:41
  relationship between the member and their health system
• 15:45
  or their primary care office, and it works
• 15:48
  best when the member feels like that system
• 15:50
  is genuinely
• 15:51
  working on their behalf and it's on their
• 15:53
  side.
• 15:54
  If I had to name one concrete step
• 15:57
  organizations can take right now, it's this,
• 16:00
  shift from identifying care gaps to owning care
• 16:03
  pathways.
• 16:04
  Full stop. That framing distinction is everything. Identifying
• 16:08
  a care gap means you know someone is
• 16:09
  overdue for a screening.
• 16:11
  Owning a care pathway
• 16:13
  means you have committed to ensuring that the
• 16:15
  screening actually happens,
• 16:17
  that the results are managed, that follow-up is
• 16:19
  coordinated, and that nothing else falls apart at
• 16:22
  the handoffs.
• 16:23
  And across color populations, we see
• 16:25
  fifty three percent of screening eligible members
• 16:28
  who are not current on one screening or
• 16:31
  more. And that's not a data problem. That's
• 16:33
  just a follow through problem.
• 16:35
  It requires a model built around accountability,
• 16:37
  not just reporting. And And for organizations who
• 16:40
  make that shift from insight to true execution,
• 16:44
  identification to full on, you know, care pathway
• 16:47
  management, those are the ones that will see
• 16:49
  real improvement in outcomes and real reductions in
• 16:51
  the cost of late stage cancer care.
• 16:54
  I think in the case of cancer care,
• 16:56
  it's perfectly fine to be passionate. I think
• 16:59
  it's very, very important, in fact, Alexandra, to
• 17:02
  be passionate
• 17:03
  about this because it's so important that we're
• 17:05
  improving this for the future. It's great to
• 17:06
  have you on. I appreciate your time. I
• 17:08
  wanna close this out with just is there
• 17:10
  anything that you wanna mention, that you've thought
• 17:12
  about in this space that that we don't
• 17:14
  talk about enough? Anything that that you wanna
• 17:17
  highlight as we close out our conversation today?
• 17:20
  I think so. I think the only thing
• 17:21
  that I'll leave you with is, you know,
• 17:23
  most organizations that I engage with, at least
• 17:25
  at the onset,
• 17:26
  you know, said, oh, we have a screening
• 17:28
  program operationalized.
• 17:29
  When our members turn 45,
• 17:31
  we mail at home colorectal cancer screenings, and
• 17:34
  we put you know, we do telephone based
• 17:37
  outreach for individuals who are 40 females,
• 17:41
  reminding them to get their mammograms, and those
• 17:44
  programs
• 17:45
  serve a purpose, and they have the best
• 17:47
  of intentions. Right? But you need to augment
• 17:49
  that approach
• 17:51
  with a partner that is accountable for closing
• 17:54
  those screening gaps and measuring on the impact
• 17:57
  and the results.
• 17:58
  And I would say, you know, to listeners,
• 18:01
  don't
• 18:02
  overlook the investment
• 18:03
  into an evolving continuous strategy because it's important,
• 18:07
  and
• 18:08
  and the cancer landscape isn't changing. If anything
• 18:10
  else, it's just getting more challenging to manage.
• 18:13
  Thanks, Erin. It's so great to have you.
• 18:14
  Thanks for your time and insights today. Likewise,
• 18:17
  Lucas. It was a pleasure.
• 18:18
  And we also want to thank our podcast
• 18:20
  sponsor, Kaller. You can tune in to more
• 18:22
  podcasts from Becker's Healthcare by visiting our podcast
• 18:24
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