Articles | October 28, 2022
Our latest short quarterly roundup of healthcare news for plan sponsors covers:
For most plan sponsors, oncology is now the number one disease category in terms of health cost spending. As the U.S. population ages, 77 percent of cancers are diagnosed in people over age 55. Nearly 40 percent of American adults are obese, which increases the risk of cancer. High-risk behaviors, including excessive alcohol consumption, tobacco use, excessive sun exposure and use of tanning devices contribute to increased cancer prevalence rates. Additionally, during the pandemic, many people missed preventive cancer screenings, which could lead to diagnoses of more advanced stage cancers.
While some risk factors (e.g., age and genetics) can’t be changed, actions reduce or eliminate exposure to cancer-causing factors. Plan sponsors may want to consider cancer prevention education that focuses on:
The earlier cancer is caught, the easier it will be to treat. Screening increases the chances of detecting certain cancers early. The ACA requires preventive screenings to be covered without cost sharing. Communicate screening recommendations annually and educate participants on the benefits of early detection.
Providing support at diagnosis and during treatment has the highest impact on quality and cost. Treatment decisions should be made after discussing all cancer treatment options. Pathology has high variability in accuracy and will impact diagnosis and treatment. Consider these strategies that aid accurate diagnosis and treatment:
Proper medical management can improve cost, quality and patient experience. Focusing care management on the highest-stage malignancies reduces the impact to the overall population. Provide support for uncomplicated, lower-stage cases with a focus on the social and behavioral health needs of this population.
Ensure accurate diagnosis and treatment through:
Plan sponsors are preparing to comply with the prescription drug reporting requirements of the Consolidated Appropriations Act of 2021. By December 27, 2022, they must report to the federal government certain information concerning their plans’ Rx costs. Learn more in our August 30 insight.
The Inflation Reduction Act extends premium subsidies in the ACA marketplace and lowers prescription drug prices and out-of-pocket costs for Medicare participants. The law has the potential to significantly affect plan costs for both prescription drugs and retiree Medicare supplemental programs, particularly Employer Group Waiver Plans. Read more in our August 10 insight.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.
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