Roundtable sessions at NCCN meetings get to the heart of today’s oncology issues. The topics are diverse and offer differing perspectives from panelists who bring broad insights to prevalent discussions. For example, a roundtable at the recently held NCCN annual meeting titled, “Cancer in Corporate America – Business as Usual?” explored the role of US corporations in today’s health and cancer care continuum.
Our system of having employers providing health insurance is fairly unique as compared with the single payer systems in Europe and elsewhere. In this roundtable discussion, moderated by the veteran ABC News correspondent Sam Donaldson, the high cost of cancer care is a given, and the panel moved beyond that issue to discuss the role an employer has in covering the cost of cancer care.
According to Donaldson, “58% of non-elderly people in the US get their primary health insurance from their employers,” and he asked the panel to discuss just what does business as usual mean in this case, and what does an employer owe its employees? As the cost of cancer and healthcare continues to rise, it could be the employer that is thrust to the center of the debate.
Robert W. Carlson, MD, of Stanford Cancer Institute, Stanford CA, pointed out that almost always when someone is diagnosed with cancer, the first question he or she asks is “How will this change my life?” But, to Carlson, what that person is really asking is: What does this mean to my job security? Is my insurance adequate? And, will my employer discriminate? To answer Donaldson’s question, Carlson said that “Businesses owe their employees support both professional (your job is safe) and emotional (such as a phone call from the employer).”
Following up on that thought, Helen Darling, President, CEO of the National Business Group on Health, a non-profit organization devoted exclusively to representing large employers' perspective on national health policy issues, said that “employees are the only appreciable asset a company has, most every other asset depreciates over time, and great companies invest in their employees.” That investment, she indicated, includes healthcare coverage for cancer. She says that companies have to be sure that employees have the tools and resources they need when diagnosed with cancer.
Practical in his perspective, J. Randall MacDonald, Senior VP of HR at IBM, which employs more than 500,000 people with healthcare benefits, said that “investing in employees is a business proposition. A healthy employee is a productive employee, and a productive employee is an innovative employee.” MacDonald believes that patients, providers, and plans all need to collaborate with each other in order to provide a means of prevention, detection, and evidence-based medicine to deal with health concerns effectively.
But, Sheri McCoy, Vice Chairman of the Executive Committee of Johnson & Johnson offered that in order to move from disease care to preventive care, education and an environmental shift is required. For instance, at J&J, she informed, they have eliminated all smoking in the workplace, they focus on healthy diet, and the company has put gyms and fitness centers throughout the workplace. “These tactics help us achieve a return on investment with employees,” she concluded.
The Goodyear Tire & Rubber Company, represented by J. Brent Pawlecki, MD, said that their company goal is to have healthy, engaged, productive employees. In order to meet these goals, he says, Goodyear plans on providing prevention whenever possible, and when prevention isn’t possible to get employees into the right care, and when the right care is no longer available, the company plans to ensure a dignified and respectful exit. Mr. Pawlecki says that “corporate America has covered prevention and treatment well enough, but that Goodyear and others need to do more to help employees with the inevitable.”
At this point in the discussion, Mr. Donaldson shifted the emphasis of the panel over to the cost of healthcare coverage.
According to MacDonald, out of the roughly $1.2 billion IBM spends on healthcare benefits, about $110 million of that is for cancer care. “Obviously, IBM has to pay attention to cost, and is trying to reduce healthcare costs. Oftentimes, controlling costs leads to very difficult decisions,” but, MacDonald thinks that IBM has the best interests of the employee in mind.
Discussing the important topic of waste, Darling said that “we know that there is something around 20%-30% waste in the healthcare system” and removing that waste would allow more room for effective care.
Dr. Carlson responded that Stanford struggles with costs almost every day, and those struggles are mostly related to structures such as prior authorizations overlaid on the medical system to control costs while adhering to evidence-based medicine. He added that companies are usually advocates for employees, and that when it comes to controlling costs, companies are mostly negotiating coverage with insurance providers.
He provided a case example of a woman with breast cancer whose insurance company would not provide coverage of an FDA-approved regimen or coverage of any breast cancer therapy that was not generic, meaning the patient could not take advantage of any of the new breast cancer agents and regimens. “Perhaps an extreme example,” he said, “but discouraging nonetheless.” In this case, the manufacturers “stepped up to the plate” and provided the medication free of charge.
When the discussion moved into healthcare reform, Kavita Patel, MD, MSHS, of the Brookings Institution’s Engelberg Center for Health Care Reform was given the opportunity to bring her unique perspective to the panel. Mr. Donaldson asked, “If you’re a cancer patient, does the ACA help you?” Dr. Patel thought it helped immediately, because the ACA removes the opportunity for a health insurance company to not accept a person into their plan because of a pre-existing condition. “They call it an even playing field now because this stipulation makes private insurance just as accountable as employer-based insurance,” she said.
Insurance exchanges, said Dr. Patel, “will help cancer patients because the ACA allows you to purchase insurance that is not outrageously expensive if you don’t qualify for Medicare/Medicaid and you do not work for a company that provides health insurance. Unfortunately most of these people can only afford catastrophic care in the current system.”
Although the new ACA law will not go into full effect until 2017, Donaldson asked the panel if they liked the ACA provisions. Ms. Darling made the point that it is a big step forward for uninsured people to gain access to insurance coverage.
What bothers Mr. MacDonald of IBM is not the content of ACA, but the unknown. For example, multi-state employers like IBM have a single control point at the federal level rather than having 50 different benefit departments. He says that they are worried that some of the ability to control healthcare will be delegated to the States and they may ignore the federal regulations; especially when it comes to healthcare exchanges and the employer’s only recourse is to sue the State to protect the employee. Then there is the perception that the employer is therefore against healthcare. Managing the unknown can get expensive.
As legislators, justices, doctors, insurance companies, employers, and importantly patients struggle with how to manage the burden of cost in the US healthcare system, it is clear that there isn’t a easy answer and that sacrifices will need to be made. One thing about this particular panel is that there seemed to be agreement that some employers are doing the right thing in providing coverage and advocating for employees, and that there is hope that all companies in the US will follow those providing excellent examples.
by Don Sharpe
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