A Guide To The Changing Health Care Landscape
In today’s unpredictable health care environment, employers are challenged to provide access to high quality care that is both comprehensive and affordable for employer and employee alike. This can be daunting for business owners as they face myriad financial challenges on a daily basis.
While health care costs are certainly top-of-mind for most employers, it can be particularly challenging when serious and/or chronic illness comes into play, such as cancer. This scenario may raise new questions and concerns that business owners are not equipped to handle. We spoke with Michael McMillan, Chief Access Officer, Cancer Treatment Centers of America <sub>®</sub> (CTCA) and Kathryn Mattson, Director of Small Group Sales and Support, Blue Cross Blue Shield of Arizona (BCBSAZ), to help employers navigate uncharted territory.
Mattson recommends employers start by ensuring their workforce has proper access to information about the health care plans available to them, the benefits included and any supplemental insurance options that may cover chronic illnesses. For example, if certain plans offer early detection screenings for cancer, kidney disease or other diseases, employees should be made aware of those benefits so they may utilize them.
Mattson also states that there are many options for business owners to choose from based on their workforce and business needs. Choosing an Affordable Care Act (ACA) compliant plan, for example, means employees will be automatically covered for cancer treatments or other chronic illnesses. ACA plans also include preventive services at no charge to the employee, including screenings.
“It’s critically important for employees to visit their health care provider for preventive services,” says Mattson. “Whether that’s going in for an annual physical, mammogram or routine colonoscopy, they’re covered at no charge for employees in ACA compliant plans.”
Many employers also don’t realize the power they have to negotiate preferred care providers into their health care plans. When it comes to some of life’s larger health hurdles, everyone wants the best provider available. McMillan sees this quite a bit through his work with CTCA®. The better a patient’s care is coordinated and the more supported they are, the better their outcome may be, according to McMillan. And a better outcome is great for everyone in this situation.
“Cancer is increasingly a chronic illness,” says McMillan. “Understanding that it can be a long-term process and making sure employees have access to the medical care and support they need is key.”
With regard to cancer specifically, which is the second leading cause of death in the U.S. and remains a top health care concern, McMillan suggests making sure employees are taking part in oncology medical home, where care is better coordinated. For those unfamiliar with the term, oncology medical home is a patient-focused model that delivers quality, coordinated and efficient cancer care. Employers should ensure this is negotiated within their payer contracts and available to their employees. For instance, CTCA offers its patients care managers or nurse navigators, nurses who serve as point people for patients and coordinate treatment logistics—book appointments, fill prescriptions, follow up on lab results and more.
“The employer may not be aware of the need for good coordination and good information and how critical that is to managing an illness that’s increasingly chronic,” says McMillan. “A care manager works closely with the patient to ensure the right things happen. So employers should be certain that any health care plan in which they invest, and any preferred care provider they use, offers care coordination as part of their service offering.”
Employers also need to be prepared to give employees the time needed for necessary treatments and care. While the employee is out, employers can ask the rest of their team to divide up the work or look into bringing in a temporary employee to assist with the workload. This is what Mattson did when one of her employees was diagnosed with breast cancer and had to be out of the office for six months.
“We made sure her tasks were covered,” says Mattson. “One of the things I realized as she was going through this experience, was that because we really supported her through the process, it created a loyalty and longevity with our company. That employee went from being a low performer during her time of illness to now one of my top performers. She’s one of the strongest sales reps that I have on the team, and I think we have a good relationship because we were all there to support her in her time of need.”
Mattson urges that the time for employers to organize their health care plan is right away, so employees know exactly what benefits and resources the company provides ahead of time, rather than trying to figure things out after a diagnosis.
“An employer would be well advised to get ahead of it and say, ‘let’s make sure we understand what’s available for our employees that might be going through this particular situation,’” says McMillan. “If [a business owner] had that conversation in advance so the employee understood that their health plan has a care coordinator and a patient advocate to help them with what needs to be done, it would be reassuring.”
Outside of care quality, cost is another important factor that business owners must consider, and health care providers such as CTCA and insurance companies like BCBSAZ are tuned into those concerns and work behind the scenes to find ways to make health care less of a burden.
“Cancer Treatment Centers of America has done a lot of work to provide lower-cost outpatient settings for chemotherapy and radiation therapy so the benefits can be used as effectively and efficiently as possible,” says McMillan. “That’s very important when you think about delivering value to an employer. You make sure the employee has the services that are needed in a convenient location, and the employer is paying for those services in the most efficient way possible.”
Mattson discussed how BCBSAZ is also taking measures to make it easier for employers and members to navigate the health care system. “The health care landscape is constantly evolving,” says Mattson. “I’ve been in the health insurance space for more than 20 years, and I’d say, in the past 10 years in particular, things are changing at lightning speed. At Blue Cross Blue Shield of Arizona, we make it a point to evolve and change so we can meet our customers how and where they want to be met.”