Cancer and Corporate America: Business as Usual?

Audrey Andrews

June 2012, Vol 3, No 4 - NCCN Conference

Hollywood, FL—Is corporate America doing enough to promote optimal cancer care? The provision of insurance coverage alone is no longer sufficient for America’s workers. Advocates for persons with cancer contend that professional and emotional support should also be part of the “benefits package” that companies offer.

At the 2012 Annual Conference of the National Comprehensive Cancer Network (NCCN), representatives of national and international corporations, oncologists, patient advocates, and government advisors convened to address the topic of corporate America’s responsibility toward those with cancer.

A Healthy Employee Is Good Business

Expressing the general sentiment of the panel, Robert W. Carlson, MD, of Stanford University Medical Center and Chair of the NCCN’s Breast Cancer Panel, said, “We need to make sure the system is configured so that employees can effectively fight their cancer and not waste their time fighting their insurance companies or being concerned about their employment.” Patients with cancer inevitably worry about how their diagnosis will affect their employment, he observed. “What businesses owe their employees is professional support—assurance that their careers will not be torpedoed by their diagnosis and that they will not be abandoned by their company during this process—coupled with emotional support,” Dr Carlson said.

When companies do this, they are also helping themselves, some said. “The reality is that a healthy employee is a productive employee. A productive employee is an innovative employee. And an innovative employee creates products and services that are satisfying to the client or customer,” according to J. Randall MacDonald, Senior Vice President of Human Resources at IBM.

Helen Darling, Chief Executive Officer of the National Business Group on Health, added, “Company executives want to do the right thing, but it’s also in their company’s best interest. They know that the way the employer responds [to illness] is a signal to everyone as to the culture of that company.”

Commitment to cancer care (or any illness) is part of the “leadership DNA” in exemplary corporations, Ms Darling suggested. Such companies send the message, “We care about you,” and provide a variety of tools and resources for dealing with cancer, including help with physician referrals, patient navigators, employee assistance programs, and the like.

One company that has gone the extra mile is in San Francisco, CA, the leading cloud computing provider, represented on the panel by John Greene, Director of Engineering. When Mr Greene was diagnosed with acute myeloid leukemia in 2010, his company helped secure a consultation with a nationally recognized hematologist and began a bone marrow registry to help him find a donor. “This stuff just happens in my company. No questions asked,” Mr Greene said.

Preventing Disease Is Good for Employers

But the need is broader, the panelists maintained. “We know that a healthy employee is one who is going to contribute in meaningful ways,” said Sheri McCoy, Vice Chair of the Executive Committee at Johnson & Johnson, which aims to move from “disease care” to “preventive care,” she said. Her company promotes smoking cessation, healthy eating, and fitness, because disease prevention, she said, “is a good business proposition,” both for the company and the individual.

Brent Pawlecki, MD, Chief Health Officer at Goodyear Tire & Rubber, agreed, suggesting that corporate America generally does a decent job providing coverage and support for cancer treatment, but tends to abandon workers toward the end of the cancer continuum. At Goodyear, he said, “the goals we have set are to prevent illness whenever possible, and when it is not, to get people into the right care at the right place at the right time and, when treatment is no longer possible, to assure a dignified and re – spectful exit. We need to help employees plan for the inevitable, whatever form it takes.” Mr MacDonald added, “We have to provide a sense of prevention, detection, and ultimately—in those unfortunate cases—end-of-life care, and to use evidence-based medicine to do these things effectively.”

Carole Klase, PhD, a mental health specialist and cancer survivor, argued that psychosocial services should be part of comprehensive cancer care as well. “The psychological difficulties in dealing with cancer can be as staggering as the cancer itself, and perhaps more so,” said Dr Klase, who survived Merkel-cell carcinoma but found the financial burden of her treatment to be a great source of emotional stress.

Cost Is the Obstacle

The increasing recognition that patients with cancer need a wide range of services unfortunately coincides with the need to reign in healthcare spending, the panelists acknowledged.

IBM spends $1.2 billion on healthcare for its US employees alone, approximately $110 million of which is for cancer. “We have very tough decisions to make,” said Mr MacDonald. “I like to think we err on the side of the employee, but I can’t say we do this every time. In reality, we have to run a business.”

Living with advanced renal-cell carcinoma himself, he can appreciate the problem. “It’s mind boggling, the cost of my cancer to my own insurance plan. I have taken sunitinib for 5 years, at $60,000 a year,” he said. “I think employers want to do the right thing. They just want to be able to understand how we can control our business model in the end.”

From the provider’s point of view, “struggles with costs” are a daily occurrence, Dr Carlson added. The most troublesome are costs related to “structures that are overlaid on the medical system in order to try to control costs,” such as preauthorization procedures and those aimed at assuring compliance with evidence-based medicine. Although the companies themselves do not directly spawn these frustrations, they approve the benefits packages, he noted. “Fighting these battles takes literally hundreds of hours of staff time,” he said.

The Potential Impact of the ACA

The Patient Protection and Affordable Care Act (ACA) will clearly affect employers and employees alike. Kavita Patel, MD, Managing Director for Clinical Transformation and Delivery at the Brookings Institution’s Engelberg Center for Healthcare Reform and former Director of Policy for the White House Office of Intergovernmental Affairs and Public Engagement, helped draft the legislation. She said the ACA puts patients in a better position regarding insurance eligibility and coverage. “It’s definitely helping by putting private insurance regulations into place and by providing a more even playing field.”

Ms Darling added that expanded coverage is not enough; it should involve not just more healthcare, but evidence-based care. Dr Patel noted that, “there still needs to be a system of checks and balances to make sure these things are executed. That is actually what the exemplary companies, such as those represented on this roundtable, can do.”

Although the ACA contains “some phenomenally good things,” businesses fear that providing these benefits will be very costly. “It’s not the content of the law, it’s the unknown that is bothering us,” said Mr MacDonald. “We are not against healthcare. We are just trying to put it in the context of what we need to do to control our costs.”