Enhance cancer care

Cancer is the second leading cause of death in the United States and costs the healthcare system billions of dollars each year. Modifiable cancer-risk factors, such as tobacco use, alcohol consumption, excess weight, lack of exercise and exposure to UV light, are associated with 40 percent of cancer cases, as well as 50 percent of cancer deaths.

Early detection and diagnosis of cancer are critical for good health outcomes and lower-cost treatment. Late-stage cancer diagnoses are associated with poor health outcomes and intensive, high-cost treatments. The pandemic has adversely affected cancer detection and care in three major ways:

1. Cancer-screening rates dramatically declined in response to the delay and cancellation of non-essential services.
2. The pandemic disrupted cancer care and treatment.
3. The pandemic has exacerbated disparities in cancer incidence rates, treatment quality and mortality rates.

Breast, cervical and colorectal screening rates were more than 85 percent lower in March and April 2020 compared to their 2017, 2018 and 2019 rates. After April, the number of screenings increased; however, as of August 2020 (the latest data available), rates were still below 2019 levels.

According to a survey conducted by the American Cancer Society, 55 percent of cancer patients getting active treatment experienced some type of disruption in their care due to the pandemic.

Even before the pandemic, social determinants of health contributed to lower screening rates, higher incidence rates, higher frequency of late-stage diagnoses, higher mortality rates and lower-quality treatment among groups with poor or no access to cancer detection services and care. These groups include people historically discriminated against based on race, disability, sexual orientation, gender identity and other traits. The pandemic is worsening these disparities, as these groups are less able to access timely care.

Because of the pandemic’s negative impacts on cancer care, the American Association for Cancer Research projects an additional 10,000 deaths from breast and colorectal cancer during the next 10 years.

Plan sponsors should focus on strategies to combat these disruptions to cancer detection, care and treatment. Strategies include:

• Educating participants about lifestyle habits that can prevent or lower the risk of developing cancer
• Encouraging participants to discuss cancer-screening options with their providers
• Designing a plan that includes strong care management programs, second opinion vendors and contracts with centers of excellence to ensure high-quality treatment for cancer patients

Monitor ER use

Health plans closely monitor ER use due to the high costs associated with ER visits, as well as out of concern that some participants seek care at the ER for non-urgent medical conditions.

As noted in the chart on page 1, the pandemic has changed ER use. Fear of exposure to COVID-19 may lead to deferred care even when patients should be seeking treatment for life-threatening conditions. The CDC reported that ER visits were 42 percent lower from March 29 through April 25, 2020 compared to the number of ER visits during the same time in 2019.

Of particular concern are studies reporting declines in ER use for truly urgent conditions, such as heart attacks and strokes. According to Epic Health Research Network, ER visits for those conditions were 45 percent and 38 percent lower, respectively, in late March/early April compared to pre-pandemic rates. JAMA, the Journal of the American Medical Association, also reported declines in ER visits for these conditions and an increase in number of non-COVID-19-related at-home deaths.

It is important to monitor these ER use patterns, as avoiding care for emergent conditions will result in worse health outcomes for participants and potentially higher costs for plan sponsors. As the pandemic continues, plan sponsors should educate participants about the appropriate uses of telemedicine, urgent care and the emergency room, respectively, and encourage participants to use the ER only for truly urgent situations. Additionally, plan sponsors should continue to expand and promote the use of telemedicine. Participants can use telemedicine to triage their symptoms and determine if a trip to the ER is necessary.