The Northeast Business Group on Health (NEBGH) has announced the launch of a free guide to help employers better understand and make decisions about genomic medicine and genetic testing. The guide explains basic concepts, including the ways in which genomic medicine is being used for diagnostics and treatment.
As genetic testing and genomic medicine continue to gain steam in oncology and cardiology as well as maternal and mental health, the Northeast Business Group on Health has developed a new guide to help employers better understand the fields and make coverage decisions.
Studying genes can help determine an individual's chance of developing certain disorders and diseases and help diagnose conditions and personalize treatment plans. While the genetic testing and genomics show significant potential, they can be difficult to understand and costly for employers to cover for their employees.
"It is hard for employers to track the science and what is good and what is not," said Dr. Mark Cunningham-Hill, medical director at NEBGH. The guide can help employers ask the right questions.
According to NEBGH, some examples of questions employers may want to ask company leadership and about their health plans: To what extent does the company want to reward specific behaviors, such as genetic screenings for cholesterol, that could lower costs? When it comes to cancer, how big a factor is cost in deciding what to cover? And, if the employer's health plan does not cover a specific test ordered by an employee's doctor, how does it want to handle that physician's request?
"The cost element is considerable," Cunningham-Hill said. For instance, certain cancer therapeutics under the umbrella of genomic medicine can cost hundreds of thousands of dollars, if not millions, he said. And employers also may need to weigh whether the potential benefits of a $2,000 to $5,000 genetic diagnostics test outweigh its costs.
NEBGH plans to update its new guide every one to two years, as the science behind genetic testing and genomic medicine continues to evolve, he said. —Jennifer Henderson
"Employers usually provide benefits coverage for standard forms of genetic testing -- screening for Down syndrome in high-risk mothers, for example -- but in general, benefits consultants don't recommend coverage of consumer genetic tests.... Employers should ask how testing will be integrated with health-care delivery and make sure doctors ordering the tests do not have financial relationships with genetic testing vendors."
There's a lot of promise—but also a lot of hype—around the still-emerging science of genetic testing for consumers.
Even so, there are plenty of national brands such as Levi Strauss, Instsacart and Visa that have begun offering insurance coverage for their employers for tests such as screening for hereditary risks for certain cancers and high cholesterol.
But how do employers figure out what's worth covering—and what might not be worth it? The Northeast Business Group on Health this week dipped a toe into those questions Tuesday, releasing a guide exploring some of the top questions employers should be asking of health plans about their coverage amid the proliferation of new genomic offerings.
Northeast Business Group on Health (NEBGH) launched “Improving the Cancer Patient Experience: Putting Employees at the Center of Your Cancer Benefits Strategy,” a guide designed to help HR and benefits leaders organize, coordinate and provide the best possible experience for employees and family members with cancer. It is free to employers and the public.
By the end of this year, an estimated 1,735,350 new cases of cancer will be diagnosed in the U.S., with 609,640 people expected to die from the disease, according to the National Cancer Institute at the National Institutes of Health. In addition, it stands to reason that cancer in the workplace is among the toughest healthcare challenges affected employees face. According to the Northeast Business Group on Health, in fact, a cancer diagnosis ranks among the most complex workplace health issues. “Fear is the single word we hear most often to describe people’s experience with cancer, and benefits leaders often face helping employees navigate this terrain,” says Candice Sherman, CEO of the New York City-based employer-led coalition. Sherman adds that employers equipped with a better understanding of the cancer experience can facilitate early intervention to achieve the best possible health outcomes and provide a caring experience for employees. To that end, NEBGH now offers a free guide, Improving the Cancer Patient Experience: Putting Employees at the Center of Your Cancer Benefits Strategy, designed to help HR and benefits leaders “organize, coordinate and provide the best possible experience” for employees and family members with cancer. “We believe this guide will help employers create a more coordinated approach to providing benefits that revolves around the employee,” Sherman explains. Among other strategies, the NEBGH guide provides employers with ideas about how to create what it calls a “huddle”—a command-center model that coordinates employee and family medical benefits, cost-effective and high-quality care, and social and emotional support. Following its football analogy, the huddle includes multiple industry stakeholders including health plans, second opinion and care navigation services, wellness coaches, and disability managers who can provide services and support for a cancer-stricken employee or family member.
While cancer remains one of the most dreaded diseased in the workforce and in life, many of the benefits that companies offer are not being utilized to their fullest extent, according to a new guide published by Northeast Business Group on Health released this week. The guide, “Improving the Cancer Patient Experience: Putting Employees at the Center of Your Cancer Benefits Strategy,” aims to provide human resources and benefits leaders with details on how to best help employees dealing with a cancer diagnosis. “Benefits leaders need to be thinking about not just that employees get the right clinical care at the right time, but be prepared to address other issues that surround this very complex illness,” says Candice Sherman, chief executive officer of NEBGH. Employers have already made strides to add new services to their standard cancer benefit offerings, but patients are often unaware these benefits exist, says Sherman. In some cases, a health plan may only learn about the employee’s condition months after the diagnosis when the patient’s insurance claims are being processed. In other cases, an employer may have too many vendors involved in the cancer care discussion, which can lead to frustration and confusion for the patient or caregiver. Employers can do a better job helping patients to utilize cancer benefits by developing a more streamlined approach to dealing with cancer, says NEGBH. The new guide provides suggestions for employers on how to improve the patient experience. Cancer is a complex disease that requires input from medical experts, case managers, disability managers, pharmacy benefit managers and others, and if benefits leaders do not have streamlined communication across all vendors, this can frustrate the patient, and caregiver, Sherman says. “The danger is sometimes you end up with an array of vendors who are not necessarily in communication, or collaboration with one another,” she says. “It could mean things like an employee or family member is getting repeated calls asking the same questions from a variety of different people.” Sherman suggests that benefits leaders make employees aware of the cancer benefits the company offers on a recurring basis. Regardless of the size of the employer or the type of benefits offered, communication is key. Sending out information once a year just isn’t going to cut it, she says. “Because when you’re facing a diagnosis, the last thing you want to do is start sorting through all of your paper work,” she says. The guide details multiple strategies for benefits leaders assisting an employee that just received a cancer diagnosis. It suggests a “cancer care huddle” where a benefits leader coordinates with multiple stakeholders to ensure the employee receives the best care. The guide emphasizes a step-by-step plan for employers after a patient receives a cancer diagnosis, like obtaining a second medical opinion to ensure correct diagnosis and confirming the patient is comfortable with their treatment plan. The better coordinated the services, the guide notes, the more likely they are to be used effectively. Sherman adds that many employers make outside services, like local and national cancer resources, available to patients when necessary. For example if any employee is concerned about the financial burden of cancer care and expensive treatments that may not be covered by their health plan, a benefits leader can refer them to outside service that may be able to assist them. “Even [smaller] employers that may not have these types of support services or vendors available, there’s always something we can do to help smooth the path for employees or family members with a cancer diagnosis,” Sherman says. Another key element of cancer care is making sure that employees have access to mental healthcare. A cancer diagnosis can be overwhelming, and employers should not neglect the emotional toll it can place on an employee and their family, Sherman says. Social and emotional support should be one of the first considerations a benefits leader takes upon learning about an employee’s cancer diagnosis. “There’s a heavy duty fear component that doesn’t necessarily accompany other diseases and conditions,” she says.
A new guide developed by the Northeast Business Group on Health aims to help employers navigate the clinical and emotional complexities of offering cancer-care benefits. When employers have an understanding of those benefits, it leads to better outcomes for employees and family members facing a cancer diagnosis, according to the business group. "Cancer repeatedly is near the top of our members' lists when it comes to conditions of concern," both from the perspective of the severity of the illness and the cost of care, said Candice Sherman, CEO of NEBGH. While many large employers have expanded cancer resources for employees and family members through care coordination and second-opinion services, these efforts are not always as well coordinated as they should be, said Sherman. The guide, called "Improving the Cancer Patient Experience: Putting Employees at the Center of Your Cancer Benefits Strategy," suggested creating command centers or "huddles" to coordinate cancer benefits to achieve better outcomes for employees and family members. In these huddles benefits leaders select a "quarterback," such as a nurse or care coordinator familiar with complex cancer care, to lead communication among the different parties involved in the care process, including health plans, wellness coaches and disability managers. —J.H.
Cancer diagnoses also create additional fear, stress, and confusion for plan members. Employees may require extensive communications from the health plan to determine the best course of action when diagnosed with cancer. “Navigating [the complexity of cancer] calls for an approach that improves quality, manages cost and improves the employee experience,” NEGBH said. “Consider this: employees may not even be aware that their company offers a range of cancer care services. After all, an employee handbook or benefits website isn’t the first place someone turns to after learning they might have cancer. That is a moment when they are afraid, stressed and overwhelmed. But that moment — just after a cancer diagnosis — is exactly when — if possible — the benefits department should get involved.”
As they make more cancer benefits available to their employees than ever, large employers need to consider offering more help to workers who have been diagnosed with cancer to navigate the maze of options. On Tuesday, the Northeast Business Group on Health released a guide to help employers do just that. "Many employers have a variety of vendors and other people internally who can provide health to someone with a cancer diagnosis," said Candice Sherman, the CEO of NEBGH. With a "constellation" of different offerings from those vendors, newly diagnosed patients can find themselves fielding calls from different companies including their health plan, a second opinion service, a disability manager, navigation services and wellness coaches. "And a newly diagnosed cancer patient likely isn't in the best of all minds to sit down and figure out all the options that are available to them," Sherman said. One of the most important ways companies can handle this? Introduce their vendors to each other. This is crucial "so they know what the other does and can more seamlessly work together," Sherman said.