The primary mission of CancerCARE is to monitor an insured’s cancer treatment to ensure they receive evidence-based cancer care. The CancerCARE program specific benefit language ties plan benefit levels to evidence-based guideline compliance. CancerCARE has a licensing Agreement with NCCN®, which enables plans to incorporate NCCN Guideline® requirements into their plan language. This language is designed to pay higher member benefits for those physicians and members that agree to design and deliver cancer care treatments meeting evidence-based NCCN Guidelines®. The primary drivers of cancer cost increases are: 1) Overtreatment and prolonged treatment; 2) Misdiagnosis and under diagnosis; and, 3) Clinical trial care. The CancerCARE program addresses all these known drivers and more. CancerCARE monitors compliance in community settings as well as academic care settings, providing plans with the total cancer care solution.
Please contact Re-Solutions today to receive full details and preferred rates for the CancerCARE program.
Case Study- Ductal Carcinoma In Situ Breast Cancer with Recurrent Disease
A 47 year old woman received a preventative mammogram and several spots on her right breast were found. A general surgeon in her community performed a biopsy. She was diagnosed with DCIS breast cancer, a less invasive form of breast cancer. After the first lumpectomy, it was determined that the entire cluster of tumors was not removed. The surgeon then performed a second lumpectomy, but was again unable to remove all of her cancer, or what is referred to as “not clearing the margins.” Undeterred, the surgeon proposed a third lumpectomy.
Fortunately for the patient, her health plan implemented the CancerCARE Program before treatment resumed. The patient registered into the CancerCARE Program as instructed, and with two failed treatments, was forwarded to a triage nurse. The patient was triaged to the Compass Risk Group and informed she qualified for the Centers of Excellence ACCESS Program. The COE ACCESS Program nurse offered the patient full COE ACCESS for diagnosis and treatment, limited COE ACCESS for diagnosis and a treatment plan, remote COE ACCESS for diagnosis affirmation and treatment recommendations, or no COE ACCESS.
The patient chose the full COE ACCESS option for higher specialist care. The CancerCARE benefit language provides travel airfare and housing, which made COE care a reality for this patient. An initial examination and diagnostic evaluation was scheduled at a premier CancerCOE within 3 weeks. A PET Scan was performed and lymph nodes tested to determine if the cancer was staged correctly and if it had metastasized. The results indicated the disease was staged incorrectly (had progressed much further than the community providers thought) and the patient needed a unilateral mastectomy followed by radiation.
Without CancerCARE Program intervention and benefits, the patient would have continued with her community provider. A third lumpectomy would not have been a cure. The lumpectomy followed by radiation would have cost the plan at least $35,000, and worsened the patient’s prognosis, potentially creating a catastrophic stop loss claim at a later date. This one intervention created an instant ROI for the plan, reinsurer and patient.
The CancerCARE Program provides a fresh new approach to cancer management, combining medical excellence concepts and networks, NCCN® Guidelines and cancer-specific benefit language.
Please contact Re-Solutions today to receive details about our preferred rates with the CancerCARE™ program.