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Cancer, Culture & CareersOverview

Survivors in the Workplace

High cost of cancer

Taboos and stereotypes

Survivor Stories

Employer Challenges

Cancer, Culture & CareersSpeakers:

Rita Pyrillis, Senior WriterWorkforce Management

Liz Danielson, Director, Payer & Employer Initiatives, National Comprehensive Cancer Network

Brenna Shebel, Director, Institute on Health Care Costs and Solutions, National Business Group on Health

Survivors in the Workplace

There are more cancer survivors in the workplace than ever before.

Number of US Cancer survivors

American Cancer Society

High Cost of Cancer

An estimated $264 billion a year in health care costs and lost productivity.

Survivors in the WorkplaceMore than 1.7 million people will be diagnosed with cancer this year.

More than half will be between 19 and 64 years old.

80% of survivors will return to work within the first year.

American Cancer Society

The Big “C”

Cancer is no longer a death sentence.

The Big “C”Taboos and Stereotypes

During the 1950s and 1960s cancer was rarely discussed publicly.

During 1970s First Lady Betty Ford and President Ronald Reagan broke the silence.

The Big “C”Cancer is no longer taboo

Cancer, Culture & Careers

Supporting Survivors in the Workplace

Survivor Stories

Survivor Challenges

FEAR…that their careers will suffer. …that they will be perceived as weak.…fear of missing opportunities.

Survivor ChallengesWhy Do Survivors Care About Their Jobs?

A sense of purposeFinancial supportHealth care insuranceSocial support

Employer Challenges

Controlling health care costs

Developing a comprehensive approach to managing cancer in the workplace through benefit design, vendor management, wellness programs and supports for survivors and their families.

Meeting the Challenge

An Employer’s Guide to Cancer Treatment and Prevention

A 3 year initiative of the National Business Group on Health and the NCCN to help employers develop a standardized approach to cancer care.

Cancer in the Workplace: An Employer’s Toolkit on Cancer Treatment and Prevention

Cancer, Culture & Careers Workforce WebinarApril 1, 2013

Director of Payer and Employer InitiativesNational Comprehensive Cancer Network (NCCN)

Liz DanielsonDirector, Institute on Health Care Costs and SolutionsNational Business Group on Health

Brenna Shebel

Agenda

• About the National Business Group on Health (NBGH) and the National Comprehensive Cancer Network (NCCN) and their collaboration

• Project Overview – An Employer’s Guide to Cancer Treatment and Prevention

• Snapshot of Recommendations

• Preview of Tools for Employees

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NBGH/NCCN Collaboration

• NCCN has widely accepted, evidence-based resources on cancer: from risk reduction, through diagnosis and treatment, to survivorship

• NBGH has extensive experience developing resources for employers and evaluation tools, such as the WISCORESM, the Wellness Impact Scorecard and EMPAQ® (Employer Measures of Productivity, Absence and Quality™)

• NBGH and NCCN together have translated evidence into recommendations, practices and tools for employers

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About the National Business Group on Health

• Representing approximately 363 mostly large employers– 66 of the Fortune 100

• NBGH is the nation’s only non-profit organization devoted exclusively to:– Finding innovative and forward-thinking solutions to

large employers’ most important health care and related benefits issues

– Speaking for large employers on national and state health issues

• Members provide health care coverage to over 50 million U.S. workers, retirees and their families.

About National Comprehensive Cancer Network

• A not-for-profit alliance of 23 academic cancer centers across the United States; offices in Philadelphia area

• NCCN Mission: As an alliance of leading cancer centers devoted to patient care, research and education, is to improve the quality, effectiveness and efficiency of cancer care so that patients can live better lives.

• NCCN vision: To be the world’s leader in defining and advancing high-quality, high-value cancer care

• NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and other resources are widely used by physicians, nurses, pharmacists, billing staff, managed care organizations and patients

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© NCCN All rights reserved.2

• Cover the vast majority of cancers (about 98% by incidence)• Address treatment, risk reduction and supportive care• 46 multidisciplinary panels with 25-30 experts per panel• 994 panel members volunteered more than 20,000 hours in 2012

to review evidence, develop and update content• Transparent process and full disclosure of all panel members’

potential conflicts of interest• Guideline development costs covered by NCCN Member

Institution dues• Widely used as the basis for insurance coverage policy and

quality evaluation (CMS, United Healthcare, Aetna, Blues plans and other organizations)

NCCN Clinical Practice Guidelines in Oncology

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• Guidelines are applicable to most but not all patients

• The individual clinical situation determines if a recommendation is appropriate:

– Co-morbidities (other health issues)

– Genetic differences– Side effect profile of drug– Functional status– Patient choice

Application of Guidelines to Patient Care

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NCCN Clinical Resources

• NCCN Guidelines for Patients® – a subset of NCCN’s professional Guidelines translated for non-clinicians –available free at NCCN.org/patients and NCCN.com– Currently, 12 Patient Guidelines are available

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Goals for the Employer’s Guide

• Evidence-driven benefits• Evidence-based, personalized care for beneficiaries• Integration and coordination across the benefit continuum

and cancer continuum• Standardization of benefits across health plans• Vendor accountability

Cancer continuum:

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Project Overview• Health Care Benefits Plan (2011)

– General Medical, including behavioral health

– Pharmacy• Health and Productivity (2012)

– Short- & Long-Term Disability – Family Medical Leave (FML)– Employee Assistance Programs (EAPs)

• Health Promotion/Wellness (2013)– Beneficiary Education – Prevention, Screening & Surveillance– Survivorship

Working group consists of staff from NBGH and NCCN, supported by an Advisory Committee that includes representatives from all stakeholder groups:

• Employers/benefit managers• Benefit consultants• Patient advocates• Managed care plans• PBMs• Cancer centers (physicians)• Pharmaceutical industry• American Cancer Society• Disability & EAP vendors

Advisory Committee approves all deliverables.All resources developed through this

collaboration are available in the public domain.

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• Tool 1 – Quick Reference Guide: A brief summary of benefit and program recommendations across the benefit continuum.

• Tool 2 – Employer Benefit Design and Assessment: Provides practice recommendations and suggestions for comprehensive benefits, along with a methodology employers can use to assess their current benefits.

Tools currently include recommendations related to medical and pharmacy benefits, short-term disability, family medical leave and

employee assistance programs.

• Tools 1 and 2: Use to assess current benefits against the recommendations, considering guidance provided in the tools

The Toolkit

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The Toolkit

• Tool 3 – RFP and Proposal Scoring Tools: Resources to support implementation of recommendations from Tool 2.

• Tool 4 – SPD Guidance: Offers guidance to help employers translate the recommended benefit or practice into summary plan description language for beneficiaries.

• Tool 5 – Vendor Contracting and Administration: Includes reporting requirements and timing.

• Tool 6 – Vendor and Program Evaluation: Supports assessment of vendor performance and overall effectiveness of the entire set of employee benefits.

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Sample of Medical Benefit Recommendations

• Medical plan network should include access to a wide range of cancer care specialists, both in the community setting and in academic and NCI-designated cancer centers.

• Benefit plan should include access to “centers of excellence” programs for transplants, including bone marrow/stem cell transplants, and for complex and rare cancers.

Definitions and additional detail included in Tool 2.

An actuarial analysis of most of the medical and pharmacy benefit recommendations is underway. The goal is to provide information on

the net incremental cost or savings associated with adding each of the recommended benefits.

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Sample of Medical Benefit Recommendations• Benefit plan should reimburse physicians for consultation with

patients and family members about all options for care, both during active treatment and at end of life.

– Discussion topics may include evidence-based treatment options, palliative care (both during treatment and at end of life), discontinuation of treatment with curative intent and hospice.

• Benefit plan should provide coverage for routine costs of care when a patient is enrolled in an approved cancer clinical trial.

• Benefit plan should include hospice coverage for individuals with an estimated life expectancy of 12 months or less to live if their disease runs its usual course.

– Beneficiaries should have access to clinicians with training in palliative care and end-of-life issues who can address hospice and other options.

Definitions and additional details included in Tool 2.

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Sample of Medical Benefit Recommendations

• Benefit plan should cover nutrition counseling and medical nutritional therapy for individuals with cancer.

• Benefit plan should cover genetic testing and counseling for risk assessment of individuals with significant personal or family history, based on NCCN Guideline recommendations.

• Benefit plan should cover standard fertility preservation treatments when a medically necessary cancer treatment may directly or indirectly cause infertility.

• Benefit plan should cover elements of collaborative care for patients who are diagnosed with a behavioral health disorder (e.g., depression) but are primarily treated in a medical setting.

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Pharmacy Benefit Recommendations• Reasonable out-of-pocket thresholds should be established so that

cost is not a significant barrier for patients to obtain their medications.

Specialty Pharmacy programs should counsel individuals who are prescribed oral oncology drugs to reduce non-compliance and prescription abandonment .

• Medical plans, pharmacy benefit plans and specialty pharmacy benefit plans should cover evidence-based cancer treatment, whether paid under the medical or pharmacy benefit. This includes coverage for off-label use of drugs and biologics when supported by evidence, as indicated in NCCN Guidelines (categories 1, 2A & 2B).

• Benefit plan should establish parity of patient cost-sharing between the medical and pharmacy benefits.

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Short-term Disability, Family Medical Leave and Employee Assistance Programs (EAP)

Common themes:– Cancer creates productivity implications for employees

whether dealing with their own or a loved one’s cancer.– A positive impact results when integration and coordination

across benefits and programs are made a priority.– Vendors/Partners and Human Resources team need a basic

understanding of cancer-related issues (physical, cognitive, emotional) that may occur during and after active treatment.

– Reasonable work accommodations should be offered by employers when an employee is undergoing treatment, returning to work or serving as a caregiver.

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Short-term Disability, Family Medical Leave and Employee Assistance Programs (EAP)Common themes:

– Screening for depression and other behavioral health issues can be done at many times and places by physicians or other clinic staff, care management program nurses, disability case managers, FML and EAP staff.

– Treating physicians can help employees remain at work, whether the employee is the patient or a caregiver – impact on retaining income, benefits and support system.

• Time and place of treatment• Choice of treatment (e.g., oral vs. infusion)• Side effect prevention and management

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Sample of Short-Term Disability (STD) Recommendations

• Short-term disability benefit plan’s policies and practices must require operational coordination with the EAP.

• Short-term disability programs should utilize cancer-specific protocols, based on clinically validated information, for guidance in certifying and managing cancer-related disability cases.

• Disability program case managers, in coordination with the disabled employee’s supervisor, human resource representatives and, when appropriate, legal department and EAP staff, should establish criteria for determining reasonable accommodations for employees with cancer.

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Sample of STD Recommendations

• If an employee returns to work following disability leave but periodically needs time off for ongoing medical treatment related to the disability, the intermittent absences for treatment should be considered one episode of disability. The episode is limited in duration to the maximum allowable disability benefit.

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Sample of Family Medical Leave (FML) Recommendations

• Employees who apply for FML for their own illness or for caregiver leave should receive information about caregiver stress and depression and available support resources.

• Employees who apply for FML should receive information about financial counseling and assistance resources.

• FML should be integrated with HR planning and operations. HR should encourage supervisors to consider offering alternative work arrangements, reduced work schedules and assistance with reentry into the workplace and to provide a supportive environment for the affected employees and their coworkers.

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Sample of Employee Assistance Program (EAP) Recommendations

• EAP professional staff should possess basic understanding of cognitive, emotional, and physical issues associated with serious and/or chronic illnesses, including cancer.

• EAP staff should be capable of providing consultation to supervisors and HR professionals and work effectively with employees coping with cancer and other serious and/or chronic illnesses.

• The EAP should maintain a network of referral sources sufficient to meet the needs of a heterogeneous and diverse workforce. This network should be culturally competent and capable of responding to the needs of parents of employees, spouses and children.

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Preview of Tools for Employees• Cancer Benefits and Resource Guide:

– Guidance for employees dealing with a cancer diagnosis, treatment or recovery, and those concerned about their cancer risk

– Tools for employees caring for a loved one with cancer– Companion Guide for employers, managers & supervisors

• Factsheets on Need-to-Know Topics:1. Cancer Risk and Genetic Testing 2. Survivorship Issues of Concern 3. Palliative Care 4. End-of-Life 5. Advance Care planning

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www.businessgrouphealth.org/cancerClick on “All Cancer Resources” at the top of the page.

To Access the Tools:

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Contact information

For additional information about the Toolkit, please contact:Liz DanielsonDirector, Payer & Employer Initiatives, NCCNEmail: danielson@nccn.orgPhone: 215-690-0296www.nccn.org

Brenna ShebelDirector, Institute on Health Care Costs and Solutions, NBGHEmail: shebel@businessgrouphealth.orgPhone: 202-558-3024www.businessgrouphealth.org/cancer

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