Publication

Article

Oncology Live®
Vol. 25 No. 6
Volume 25
Issue 6

Quality Over Quantity: What Concierge Medicine Can Offer to Patients With Cancer and Employers

Author(s):

The current health care economy has driven many employers to self-funding models to offer affordable health care coverage to employees.

Lora Markley

Lora Markley

Legal requirements, an increasingly competitive labor market, and the rising costs of health care have driven many employers to self-funding models to offer affordable health care coverage to employees.1

Self-funded health care offers the potential of not only cost savings, but also increased flexibility in the care provided, which benefits employers, employees, and providers alike.2 These assets can be further enhanced by pairing them with the enriched quality of care and cost savings provided by a concierge medicine benefits manager.3

Factors Driving Concierge Medicine

Cancer treatment has been a top driver of employer health care costs, and the need for treatment is expected to continue to increase.4 Cancer diagnoses are associated with substantial emotional burden along with loss in productivity, which contributes to additional indirect costs for both employees and employers.5 Hence, ensuring the best possible care for a person with cancer is in everyone’s interest. This kind of dedication and care also strengthens employer-employee relationships, building the foundations for a long-term and sustainable workforce.

A happy and healthy employee is productive and loyal and is likely to continue in their role for many years. Unfortunately, patient care is often impeded by cumbersome administrative practices related to insurance approvals.6,7 The last thing a patient with newly diagnosed cancer needs is to spend weeks waiting for appointments and testing—they need immediate treatment and care to help them along their cancer journey.8

Benefits of Concierge Medicine

Concierge medicine benefits managers are professional liaisons between providers and patients who help employers tailor their health care benefits to maximize quality of care and cost savings.3 Whereas fee-for-service models emphasize high throughput, concierge medicine pushes for reduced wait times, longer and more comprehensive appointments to fully address patients’ needs and concerns, and more immediate access to necessary services.9 Instead of the patient trying to determine who can provide the best in-network care for their specific cancer type and waiting for an available appointment, a concierge medicine benefits manager conducts this research and directs them to the appropriate recommended place.10

Concierge medicine also has the benefit of potentially reducing delays associated with determining whether specific diagnostics or treatments are covered by an insurance carrier and securing the required authorizations. For example, genetic testing is a recommended standard for many types of cancer to direct patients to optimized and targeted therapies that have the best efficacy and the lowest potential for adverse effects (AEs), but coverage of this testing varies among insurance companies.7 By gaining quick access to targeted therapies, with potentially less severe AEs, patients may remain in the workforce throughout their treatment. They can also avoid treatments that are less likely to be effective, reducing costs and improving outcomes.11

In addition to having full knowledge of the best care facilities, concierge medicine benefits managers maintain a keen awareness for cost savings that benefit the employer. Indeed, cancer treatments can vary from one cancer center to another.11 Community-based care can offer a unique solution for the individual, including quality cost-effective care that is in proximity to the patient’s home. This allows for simpler scheduling and travel, ensuring quick access to needed services.12 Thus the concierge medicine benefits manager can help direct individuals to the most accessible facilities that may also offer overall cost-effectiveness. Moreover, the costs are known ahead of time, as they are not dependent on approvals and negotiations with insurance companies.

Providing health care through concierge medicine benefits employers by reducing costs and decreasing absenteeism, and investing in overall wellness helps maintain a healthy and productive workforce.6 In turn, employees get the benefit of rapid and consistent access to excellent care. This attentiveness to the whole patient throughout their illness supports overall wellness.

Finally, another factor that cannot be ignored is the benefit of concierge medicine to providers. There has been increasing burnout among providers, even prior to the COVID-19 pandemic, and now more than ever it is time to reexamine the one-size-fits-all approach of prior health care models and adjust them toward better outcomes for patients and providers alike. Some of the biggest contributors to health care provider burnout include too many patients and too little time, an inability to provide full and comprehensive care to help patients during treatments, and administrative burden.13 Concierge medicine addresses all of these by supporting team-based care to allow for more time with individual patients to fully address their needs; it also eliminates the need for paperwork and phone calls to cover insurance negotiations, billing, approvals, and reimbursements.13 Concierge medicine allows providers to spend more time focusing on helping their patients and fulfilling the primary goal of medicine.14

Conclusion

Ultimately, concierge medicine helps employers provide the most beneficial and comprehensive health care coverage more affordably. These models are tailored to provide optimized and individualized care for each employee and ensure the best outcomes to help them through their treatment. Concierge medicine benefits managers are expert guides who navigate the subtleties of quality and cost-effective care to maximize the treatment goals for employers, employees and providers alike, reducing the burden on all parties and allowing them to
focus on what matters most: wellness for the patient.

References

  1. Robertson K, Lowther C. Benefit concierge services: legal issues to know. BenefitsPRO. November 12, 2018. Accessed February 15, 2024. bit.ly/4av4S7N
  2. What is self funding? Health Care Administrators Association. Accessed February 20, 2024. bit.ly/3ITgaqS
  3. Warshaw J. Why concierge medicine is the perfect fit for self-funded employers. LinkedIn. August 12, 2015. Accessed February 21, 2024. bit.ly/4as2SNF
  4. Miller S. Cancer now top driver of employer health care costs, survey shows. SHRM. August 31, 2022. Accessed February 21, 2024. bit.ly/3VthgBf
  5. Cong Z, Tran O, Nelson J, Silver M, Chung K. Pro- ductivity loss and indirect costs for patients newly diagnosed with early- versus late-stage cancer in the USA: a large-scale observational research study. Appl Health Econ Health Policy. 2022;20(6):845-856. doi:10.1007/s40258-022-00753-w
  6. Moole H. Why employers should consider concierge medicine for employees? FindMyDirectDoctor. Updated February 27, 2021. Accessed February 15, 2024. bit.ly/3vuby7t
  7. Hopkins C. Oncologists, patients still face unpredictable payor coverage for broad tissue NGS panels. Precision Medicine Online. May 17, 2021. Accessed February 22, 2024. bit.ly/3x9goaN
  8. Phillips C. Financial navigation can reduce the financial toxicity of cancer care. National Cancer Institute. April 21, 2023. Accessed February 21, 2024. bit.ly/49bO9FR
  9. Soman N. Understand the distinction: direct primary care vs concierge medicine. Decent. October 25, 2023. Accessed February 21, 2024. bit.ly/3vq2Tmu
  10. Demyan D. How healthcare concierge services complement self-funded insurance. Roundstone. February 21, 2023. Accessed February 20, 2024. bit.ly/4a7j6fz
  11. Cancer care and the self-insured business: doing right by employees while controlling costs and improving the bottom line. Regional Cancer Care Associates. October 1, 2018. Accessed February 21, 2024. bit.ly/3TQJBA3
  12. Verrilli D. Community-based cancer care: a better all-around value. The US Oncology Network. November 2017. Accessed February 21, 2024. bit.ly/3vpcaLI
  13. Concierge health care is booming: here’s every-thing nurses need to know. Duquesne University School of Nursing. Accessed February 20, 2024. bit.ly/4apCzYA
  14. Moole H. What are the benefits of concierge medicine? FindMyDirectDoctor. Updated June 12, 2021. Accessed February 15, 2024. bit.ly/43zeGvB
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