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Association for Value-Based Care

COVID-19 Impact on the Cancer Care Delivery Ecosystem

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Employer Update

Employers are not likely to make major changes in their benefit designs for 2021, said experts in an August 12 webcast sponsored by the Association for Value-Based Cancer Care. Art Taft, MBA, Managing Director of Medworks, moderated the session with Randy Vogenberg, PhD, Board Chair for the Employer-Provider Interface Council (EPIC) of the Healthcare Quality Forum and Principal with the Institute for Integrated Healthcare, and James Startare, VP of Benefits for the food services, facilities, and uniform provider Aramark, which has more than 270,000 employees in 19 countries.

“It’s important to understand that employer-provided benefits have not changed; what’s shifted dramatically is access to the services covered by those benefits,” said Dr Vogenberg. “Things are slowly starting to recover now, but surveys conducted by Becker’s Hospital Review consistently suggest that around 40% of Americans continue to avoid care.” This means that at this point, employers are underspending their 2020 benefits budget, but Dr Vogenberg noted that many are concerned about the long-term implications.

“One employer I spoke to was talking about how odd it was that even people with potentially visible tumors were not seeking care,” said Mr Taft. “They’re wondering if at some point they will see a rush for care, at a time where many employers are losing revenues. From a forecasting perspective, if that money won’t be spent it would improve 2020 top-line reports, but there is a lot of speculation as to what happens next. They’re trying to finalize 2021 benefit designs and project against this kind of uncertainty.”

Aramark’s 2021 planning process “got thrown out completely,” agreed Mr Startare. “So much of what we do is driven by finances, and it’s hard to predict how much we will be spending in benefits. We have kept our course financially. The goal for 2021 is not to disrupt. Right now we have multiple insurance carriers, and ideally we would have liked to streamline that where possible, but 2021 is not that year for us. We’ve had enough disruption and we’re trying not to disrupt our employees’ care and providers.”

He noted that Aramark has continued to cover benefits for employees who are currently furloughed, even those who might not be expected to return to work with the company post-pandemic. “We’ve made the decision to do right by our employees.”

Virtually all employers are expecting that the dramatic shift toward telemedicine that has been prompted by the pandemic will remain even after COVID-19 is under control, Mr Taft said. “Every employer we’ve talked to expects a long-term structural shift to more usage of telemedicine. Even pre-op information for surgery is now being done via telemedicine. It’s seen as a permanent part of the healthcare delivery system now.”

While not inclined to make drastic changes in their coverage for 2021, Dr Vogenberg said that employers are still seeking more coordinated services. “They want to coordinate with providers and have services more pulled together and organized, in order to deliver on clinical effectiveness. There is much more engagement by employers now, not just at large companies but at all levels, than there has ever been.”

Medworks has observed significant redundancies in patient support services, Mr Taft noted. “A lot of treating clinics have follow-up services, and while those services might be excellent at one individual clinic, at the next they might not be,” he said. “Employers are looking for more standardized services, but COVID has interrupted any aggressive review of how to approach these.”

With people less willing to travel, Dr Vogenberg said that the concept of “networks of excellence” is becoming preferable to “centers of excellence.” “Patients aren’t going to want to fly across the country to a single center. Networks of providers with consistent standards and quality of care will be a big thing in 2021.”

One webcast participant inquired as to why employers do not negotiate prices directly with pharmaceutical manufacturers. “We would love to!” Mr Startare responded. “Cutting out the middleman sounds great, but we don’t have the contracts to allow it. It would be radically bucking the system…but maybe the system does need to be bucked a little.”

Dr Vogenberg noted that some employers are forming coalitions on a local or regional level that may facilitate that kind of negotiation. “That may begin to change these relationships to more of a collaborative one, streamlining the negotiation process to ensure that you’re getting best-in-class, consistent care that is not costing you a fortune.”

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