When a patient is diagnosed with cancer it is often the start of a complex and challenging journey, which requires careful navigation through every stage of care. Starting with the shock of the initial diagnosis through difficult treatments such as surgery, chemotherapy, and radiation, as well as post-treatment and follow-up care, patients face a multitude of decisions and processes that can be overwhelming.
The journey is physically demanding and takes a significant mental and emotional toll on patients, caregivers and their families. Not surprisingly, many patients with cancer also experience a decline in mental health, which emphasizes the need for comprehensive support.
The complexity of cancer makes it difficult for providers, patients, their families and caregivers to implement care plans with the necessary speed, precision, and quality. There are over 100 major cancer categories. Each has a multitude of treatment options, and a growing rate of change in treatment guidelines, which can make it difficult to navigate, get an accurate diagnosis and to receive optimal care without delay.
“We’ve learned that a holistic approach can help improve cancer diagnosis and treatment while closing potential gaps in care,” said Adam Kautzner, PharmD, president of Express Scripts by Evernorth. “When members are led to the right care, at the right time, that meets their personal needs and preferences, plan sponsors can expect better patient experiences and lower total medical costs. This approach is especially crucial to help patients find the right specialists and navigate the financial and administrative aspects of their care – so patients and their caregivers can focus on what’s important, their health.”
Driving better outcomes with patient-centric care coordination, navigation and high quality care
Evernorth Health Services has introduced Evernorth Oncology Benefit Services, which will be available to eligible commercial plan sponsors in 2025, with plans to expand over time. It empowers employers to provide an enhanced oncology patient experience across pharmacy and medical treatments while also addressing the rapidly rising cost of cancer care. It’s a single benefit that includes a holistic solution for both pharmacy and medical experiences to improve patient outcomes.
Through Evernorth Oncology Benefit Service’s personalized, digital- and mobile-based platform, patients can coordinate care across their team of clinicians and engage with their dedicated oncology nurse navigator. With a patient-centric approach, patients and their families receive the assistance they need through every step of the treatment process – with the level of care and attention they deserve.
As part of Evernorth’s Oncology Benefit Services, oncology nurse navigators who have cancer and benefits expertise help patients schedule services, collect and manage documentation, and coordinate a travel schedule, if needed. The intelligent data platform also integrates additional Evernorth services, as well as other supportive services providing a one-stop, holistic care approach for patients and their caregivers.
The benefit includes bundled payments for providers and pre-negotiated bundled rates for plan sponsors to streamline care and reduce administrative burden, while helping patients to get the care they need, when and where they need it. Patients will also have access to resources and support throughout their post-cancer journey, including return to work support.
Expanding access to the right care at the right time
Research shows that not all patients are benefiting from the latest innovations in treatment. A recent study found that almost one-third of patients diagnosed with non-small cell lung cancer, for example, did not receive the recommended biomarker testing to determine the most appropriate treatment, which points to a need for greater emphasis on quality care and a consultative approach to patient support. Evernorth’s Oncology Benefit Services helps increase patient access to high-quality providers nationwide, and helps ensure that patients get the right care at the right time.
For example, patients with common cancers, such as early-stage breast or colon cancer, have access to top-tier diagnostics and care through a network of cancer centers of excellence. Patients receive personalized guidance as they choose their clinicians based on preferences and clinician quality rankings, and may also have access to travel benefits to receive care at a designated cancer center of excellence.
For other complex cancers, such as certain types of lung, breast, colon, or other cancers, Evernorth’s industry-leading cancer consult service connects community oncologists and patients to expert oncologists at National Cancer Institute (NCI) designated centers—enabling patients to benefit from the latest advancements in diagnostics and treatment, while still receiving care close to home and family. Among eligible patients who have access to this service, more than 30% of consult reviews resulted in a material change to the patient’s diagnosis or treatment plan. Of those cases that saw a change in diagnosis or treatment, medical oncology savings averaged $17,800.
“Getting a cancer diagnosis can be devastating for patients and their loved ones. It can trigger emotions such as anxiety, stress, and depression, impacting their personal and professional lives and further complicating the treatment of their cancer,” Kautzner said. “Cancer care requires an individualized and consultative approach because the system is difficult to navigate, always evolving, and no two patient journeys are alike.”
For more information on Evernorth Oncology Benefit Services, click here.
This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by Evernorth's editorial team.
