Navigating the tumultuous cancer journey is a daunting task for patients, their families, caregivers, and even health care providers. It becomes even more difficult when social determinants of health (SDOH) impede access to expert oncologists and the most up-to-date protocols and treatments.
Rural America, where 14% of the nation’s population resides, faces a significant challenge in this regard. The American Society for Clinical Oncologists estimates that only 3% of medical oncologists are serving those communities. This disparity is increased by the closure of more than 100, or 4% of, rural hospitals from 2013 through 2020. Consequently, rural residents needed to travel an additional 20 miles for common services like inpatient care, and an extra 40 miles for less common services.
These factors, coupled with Evernorth Health Services’ prior authorization data, led to the launch of Cigna Healthcare’s Oncology Consult Service (OCS) – a collaborative solution between community oncologists and subspecialty oncologists at leading comprehensive cancer centers recognized by the National Cancer Institute (NCI). This new clinical program pairs community oncologists with experienced cancer subspecialists at NCI-designated cancer centers to perform secondary reviews of diagnoses and drug treatment plans for complex cancer cases. The program improves access to high quality and appropriate care, optimizes treatment pathways, keeps the care local, and most importantly, provides patients with the peace of mind that their individual care journey is the right one for them.
Changing lives with a change in diagnosis
“With rapidly evolving evidence, the standard of care for cancer diagnosis and treatment changes frequently,” says Dan Greden, oncology product lead for Evernorth Care Solutions, who created the OCS solution in collaboration with EviCore by Evernorth. “We noticed certain cancer diagnoses were more likely to have had a treatment revision come in because the current plan wasn’t working as expected. Because community oncologists who treat a large variety of cancers often find it challenging to stay abreast of the latest updates across all cancer types, it meant more expert help was needed to support these rural providers and patients. They can now benefit from a second opinion from subspecialist oncologists who have experience with and focus on the most up-to-date data and protocols of individual cancer types.”
Unlike oncologists who work in a large comprehensive practice setting, community oncologists may not always have easy access to obtain an expert opinion on the pathology or radiology interpretations in complex cases, which can lead to minor diagnostic errors that result in suboptimal treatment selection, says Dr. Eric Gratias, chief medical officer for EviCore by Evernorth. “This unique, concierge model of subspecialty access is making a difference to providers and patients, both in confirming and (when appropriate) changing diagnoses and treatment plans.”
Promising trends point to progress
Dr. Gratias noted that having a pathology or radiology report reviewed by these specialized oncologists had so far resulted in a 2-12% change in diagnoses. This is particularly important for rural patients who live in remote areas and often face geographical challenges such as needing to travel across two or three towns to consult a rural or community oncologist.
Gratias says close to 25% of the time a subspecialist is returning additional recommendations for biomarker testing, imaging, or other additional diagnostic testing – which all have influenced outcomes.
A powerful option for patients, providers, and plans
Gratias says community oncologists have been very appreciative of the new service, which is being reflected in the increase of requests being tracked. “It’s a differentiator for us,” says Dr. Roseleen Charania, associate chief medical officer, oncology solutions, EviCore by Evernorth. “It’s a model not readily available with competitors and what’s resonating is we’re able to keep the cancer patient at home. We’re also engaging with patients more to see how this solution might better address health equity disparities in cancer care – beyond just geography.”
“Employers tell us cancer is one of the biggest reasons they buy health insurance,” adds Dr. Gratias. “We’re seeing growing interest from employers because it’s about them ensuring optimal cancer care for their employees, and that no matter where you are, geographically, you’ll still get outstanding care.”
The OCS is enhancing cancer care access and outcomes by delivering the right care at the right time and place. By connecting members to quality, affordable providers, facilities and pharmacies, the program is creating a more inclusive and effective approach to cancer care.
Let’s give each person every opportunity to live well.
Health equity is at the heart of our business. See how The Cigna Group is driving change.