Cancer's age shift is changing the benefits equation

Cancer is becoming more common among adults under 50, reshaping assumptions about who is most likely to need high-cost care — and complicating the benefits math for employers that may associate younger workforces with lower health care risk.

Why it's important: Cancer already ranks among the top three health care cost drivers for 86% of large employers, according to Blue Cross Blue Shield of Massachusetts (Blue Cross).

But as more people under 50 receive diagnoses, employers face a growing need to support complex cancer care within a younger share of their workforce — with a health plan partner that can help members navigate it.

• The financial stakes of treatment rise quickly. Care can involve oncologists, specialists, medications, imaging, hospital care and ongoing decisions about where and when a patient should seek help.

The challenge: Complex care can create stress, confusion and unnecessary costs when patients have to navigate it without enough clinical support.

• A patient who develops a new symptom during treatment, for example, may default to the emergency room because they do not know whether the situation requires emergency care, an urgent appointment or a call to their oncologist.
• Poor coordination can create further problems; different providers may order overlapping services or make decisions without a complete view of the member's treatment.

Every additional high-cost service adds to an already expensive care journey, making a health plan partner that can guide members to the right care especially valuable.

The solution: Blue Cross recently launched its first specialty-specific, value-based oncology contract through a partnership with Thyme Care.

• Eligible members with cancer can receive 24/7 virtual support from a dedicated, oncology-trained care team, including doctors, nurses, and social workers, who help members understand their treatment, connect the pieces of their care, and decide where to turn when questions or new symptoms arise.
• Technology and clinical data help the team identify needs earlier — including symptoms, hospital transitions and other changes in risk — prompting proactive outreach, symptom management and coordination with the treating oncology team before issues escalate.

The model gives patients a consistent source of clinical and non-clinical guidance during a period that otherwise might require them to coordinate several parts of the health system on their own.

For employers, better navigation helps proactively address avoidable spending around treatment without putting the burden of cancer on HR teams or employees.

The breakdown: Blue Cross structured the partnership around value rather than the volume of services delivered.

• Traditional fee-for-service arrangements generally pay providers for each service they perform.
• Value-based models instead create financial incentives around outcomes, quality and the overall cost of care.

About 70% of Blue Cross' claims spending is tied to value-based arrangements, and research cited by the health plan found its value-based model lowered spending by 12%.

• The Thyme Care partnership brings that philosophy into oncology, where both the medical complexity and potential costs can run high.

The proof: Thyme Care reports fewer high-cost acute-care visits among members receiving its cancer navigation support.

• Its book-of-business results show a 28% relative reduction in emergency department or inpatient utilization for members who completed electronic patient-reported outcomes surveys, and members who complete Thyme Care's readmission prevention program see a 30% relative reduction in hospital readmissions
• At the same time, 83% of members said they felt more supported throughout their cancer journey.

The takeaway: As cancer incidence rises among younger adults, specialized navigation can help members make better-informed care decisions while helping employers reduce avoidable utilization around one of their highest-cost conditions.

Explore the approach.