What I learned from cancer patients about their benefits

April 6, 2016 Steven Laird

As a follow-up to my recent blog posts about the Benefits Canada Employer Cancer Care Summit (links to my previous posts are at the end of this one), I promised to share some of the insights real cancer patients provided into their benefit plans.  By now, many of you will have seen these mentioned in the pages of Benefits Canada.

"...as benefit professionals, we are not doing enough to support employees when the going gets tough." Lizann Reitmeier,
“…as benefit professionals, we are not doing enough to support employees when the going gets tough.” Lizann Reitmeier, Health Practice Leader

As a bit of background, Benefits Canada surveyed 72 employees of large employers who were undergoing cancer treatment or had undergone treatment in the past five years. The survey participants were asked questions relating to their benefits and their treatment.

Here’s what I learned.

Covering the cost

Benefit plans are doing a good job, according to the survey respondents. Most survey participants thought their benefit plan helped get them the best treatment possible. 56% of respondents did not encounter any drug plan management techniques like prior authorization or step therapy.

Not all participants indicated they used their employers’ drug plans. This may be a testament to the government-sponsored cancer programs available in some areas of the country, or the drug companies’ patient assistant programs, but I find this surprising. Many cancer drugs are now oral and administered out-of-hospital by the patient themselves. Further, there are some ancillary treatments that help the body recover faster between chemotherapy treatments. Did the patients surveyed not realize they were taking drugs relating to their treatment?

While 25% of respondents were not out-of-pocket any money as a result of cancer treatment, the average out-of-pocket amount of the other 75% of respondents was $2,091.

44% of respondents indicated there was a gap between what their doctor prescribed and what was covered by employer or government plans and 40% indicated there was too much paperwork.

One-third accessed a drug company’s patient assistance program and almost all indicated this had a high impact on their ability to access the treatment they required. Most participants were directed to these programs by their health professionals and some by their employers, but only a small number received information about these programs from their insurance company.

Getting back to work

It is human nature to want to return to work. Most employees wanted to return to work as quickly as possible following treatment or continue working throughout their treatment. Over 80% of participants indicated they wanted to work to maintain a sense of normalcy. 50% of participants also indicated they needed to work because they couldn’t afford to have their pay reduced. Surprisingly, the majority of survey participants did not even access their employers’ disability plans.

Almost half of respondents reported concerns about their colleagues’ perception of them once they return to work following cancer treatment. They worry that they will seem less capable and their careers will stall.

The next benefits agenda

So what does all this tell me? It tells me that, as benefit professionals, we are not doing enough to support employees when the going gets tough. Is $2,000 out-of-pocket “affordable”? Should an employee be worrying about the perception of co-workers when battling cancer? Are disability programs designed to support employees with the potential for periods of ability and disability while undergoing treatment? Are HR professionals trained to manage both the concerns of the employee in treatment as well as their manager and colleagues?

Are insurers, as the keepers of confidential health information, doing all they can to ensure employees have access to the services they need and support a timely return-to-work? Due to privacy restrictions, insurers paying drug and/or disability claims have much more information regarding the employee’s medical condition than the employer. They have the information required to direct employees to programs that will assist them in managing their illness, yet this is not happening. As noted above, only 21% of respondents received information from their insurer about pharmacy sponsored patient assistant programs. Could an insurer advise an employee of the other services their employer provides that could be helpful, such as EAP and disability? Is that even the insurer’s job?

New services, such as CarePath, give employees access to case managers who will help them understand their diagnosis and navigate the medical system. While this is adding another provider who may not have the whole picture, this case manager is an advocate for the employee and an additional support for questions like “When can I go back to work?” and “Is there coverage for this treatment?”

Some disability management companies and EAP providers will train managers to facilitate a successful return to work or a modified work arrangement. An educated manager can ensure the returning employee feels welcome and supported with a proper return-to-work plan and by training co-workers. Managing the expectations of both the returning employee and their colleagues may be key for a successful return-to-work, especially where an employee may have several periods of disability through a longer course of treatment.

A little Critical Illness (CI) coverage could go a long way. Cancer is covered under the most basic Critical Illness policies, although you need to be aware of the pre-existing condition exclusions and the limitations, as not all cancers are covered. With employees being out-of-pocket over $2,000 as a result of cancer treatment, a nominal CI benefit could alleviate one significant source of stress for employees with cancer.

A better way forward

Overall, I learned that, in general, employees are not unhappy with the role their benefit plan played in their cancer treatment. While this is good news, I think there are many opportunities to enhance the patient experience. The plan enhancements noted above are just a couple of suggestions that would send a caring message to employees, something that typically improves engagement scores, while supporting employees at a critical time. It’s currently a good system, but there is room for improvement.

Until next time, stay healthy!

 

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