CYPRESS U CRITICAL UPDATE

Transcription

1 CYPRESS U CRITICAL UPDATE CASE STUDIES IN CANCER CARE MANAGEMENT John Van Dyke, Interlink

2 Copyright INTERLINK Care Management, Inc. 2014

3 Presented by: John Van Dyke Chief Executive Officer INTERLINK COE Networks & Programs

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5 Slides Topic 3 Cypress Client Adoption & Enhancements 3 INTERLINK Program Advancements 6 CASE SAMPLE: Four Plans Managed By One Advisor 2 Successful & Unsuccessful Interventions 1 Summary & Closing Thoughts

6 Enrolled: 19 Employer Plans 5,049 Employee Lives Enrolled: 7 Employer Plans Enrolling: 4 Employer Plans Enrolled: 1 Employer Plan

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8 INTERLINK & Cypress Collaborate Quality Measures - National Centers & Local Providers Seattle Cancer Care Alliance Oregon Health & Science University Mayo Clinic Rochester University of Wisconsin University of Michigan Roswell Park Cancer Institute Dana-Farber UCSF University of Utah Fred & Pamela Buffett Cancer Center (UNMC) University of Iowa Northwestern University Case Comprehensive Cancer Center Memorial Sloan Kettering Johns Hopkins Stanford University of Colorado Indiana University City of Hope Duke Cancer Institute UC San Diego Mayo Clinic Phoenix St. Jude s Vanderbilt Harold C. Simmons Comprehensive Cancer Center (UTSW) University of Alabama Hollings Cancer Center (MUSC) Mayo Clinic Jacksonville MD Anderson Cancer Center Moffitt Cancer Center Projected Network Copyright INTERLINK COE Networks & Programs NCCN & NCI Facility NCI Facility Pathology/Diagnostic COE

9 INTERLINK & Cypress Collaborate Quality Measures - National Centers & Local Providers Copyright INTERLINK COE Networks & Programs

10 Program Enhancements INTERLINK Legal Team Helps With Language Insertion One Level Positive Incentive Only Two Level Positive Incentive With Limits Three Level Positive Incentive With Main Table Limits High Deductible Plans BIGS Administrator PPO & All Other

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12 CancerCARE: Implementing strategies to impact high frequency cancer types! COSTS Stg IIB Stg IV Open Clinical COE's Breast $ k CVP $ $27.7k NCCN 91 regimens up to $128.9k for Non- NCCN Clinical Trials - CVP Clinical Trials - NCCN 100 non-nccn regimens up to $128k Memorial Sloan Kettering - 4 MD Anderson - 5 Northwestern - 31 OHSU - 6 Mayo - 19 Colon $ ,900 CVP $ ,900 for NCCN 40 Non-NCCN regimens ranging from $900 - $70k with 16 being >$15k $ k for CVP $ k for NCCN Non-NCCN up to $71.8k City of Hope - 7 UCLA - 2 Roswell Park - 4 Moffitt - 5 Vanderbilt - 6

13 Program Enhancements 100% Member Engagement Goal 13

14 Employer Group Effective Date # of Lives Cov'd lives Person Years Employer Group ,496 2,992 Employer Group Employer Group Employer Group Total Person Years 4,345

15 Employer Group # of Pre-Triage # of Explorers (Low Risk) # of Navigators (Medium Risk) # of Compass (High Risk) Total Members Enrolled Employer Group Employer Group Employer Group Employer Group Total Members Called: Total Members Enrolled: SEER Predicted: patients registered already in remission. Enrolled with re-enrollment instructions

16 Incidences/year 2013 SEER - All Ages 436/100, /1, / SEER - Under /100, /1, / SEER - Over /100, /1, /100

17 Cancer Types Enrolled Number of Cases % Of Cases Breast/ Prostate 7 39% GI 3 17% GYN 2 11% Melanoma 2 11% Other (lung/head & Neck,Uro, Thyroid) 4 22%

18 Plans benefited from a close proximity to a COE. Some patient s chose COE as treatment center before triage COE Access Program Declined COE Clinical Trial PathDxCOE Limited COE Full Access Discussion Total COE Discussions: 9

19 Cancer patients often face complicated choices, CancerCARE is a toll-free resource to gather information and support them for decisions based on best outcomes Featured Case SAVINGS $6,570: Coordination of Outpatient Chemotherapy supplies, etc $165, ,146.00: Educated Member on Options and they chose risk reduction mastectomy where path showed "almost certain" breast CA so saved treatment of advanced breast CA Total: $210,716.00

20 Case #1: Opted For Community Surgery. Patient directed to COE ACCESS nurse at triage. Went to COE for evaluation, but chose to have surgery by a community doctor. What should have been an overnight stay turned into a weeklong hospitalization. Was transported to COE for recovery. Case #2: MRI Fusion Biopsies For Prostate Cancer. Patient directed to COE ACCESS nurse at triage. Treatment proposal was to watch. About 60% of prostate cancers are under staged, resulting in late stage treatments which are costly. MRI Fusion Biopsy was ordered and correctly staged. Case #3: Onsite COE Evaluation Saved Ongoing Treatment. Patient directed to COE ACCESS nurse at triage. Directed to COE for assessment. Patient s condition was assessed and palliative and hospice care was then implemented, saving the patient much un-needed care.

21 What Did The Groups Pay? Employer Group 1 (2yr x 680 EE) $19,747 Employer Group 2 (2yr x 210 EE) 6,098 Employer Group 3 (2yr x 65 EE) 1,887 Employer Group 4 (1yr x 65 EE) $943 Total: $28,676 Opportunities To Save From Major Interventions. Breast Cancer Intervention $210,716 Complications From Low Volume Surgery 65,000 COE Recommendation Facilitates Hospice Care 40,000 Prostate Cancer Treatment Initiation 25,000 Feeding Tube Management For Mouth Surgery $6,000 Total: $346,716

22 Benefit Opportunities: Cures & life extensions on the horizon Personalized treatment Better tools to manage Benefit Increase Forces: Aging workforce Cost increases EVERY WHERE Extended remission costs Benefit Opportunities: Better outcomes due to compiling volume at key COEs Benefit Increase Forces: Billed charges are rising First $16,000,000 transplant Transplanting for more conditions Better organ transporting will increase transplant rates across US

23 Thank you! INTERLINK COE Networks & Programs Contacts Phone Program Contact Extension Program Access - WEST Julie Doran Julie.doran@interlinkhealth.com 223 Program Access - EAST Marty Ward Marty.ward@interlinkhealth.com 216 More Materials Sherry Freeman Sherry.freeman@interlinkhealth.com 219 Speaking Opportunities John Van Dyke John@interlinkhealth.com 207