Seizing Critical Moments in the Cancer Care Journey

A human-centered approach to early identification and intervention

For many patients, a cancer diagnosis immediately triggers a race against time. Shock and grief quickly lead to a frenzy of action. Within the first few days or weeks of a diagnosis the average patient has selected a doctor and agreed to a treatment plan. Their cancer journey has begun, and the wheels of the healthcare system are in motion.

This urge to act quickly is not only understandable but often merited. One study found that every month of delay in cancer treatment can increase the risk of death by as much as 10%. However, data has also shown that the critical decisions made in a brief window — often under extreme duress — can have significant and costly repercussions. Initial misdiagnosis can lead to worse outcomes and much higher costs for the patient and their employer. Precious time and patient trust can be lost pursuing an ineffective, lower-value treatment. Treating relapsed or metastatic cancers is far more costly than seeking the most effective treatment from the start.

The patient’s overall experience with the cancer care journey can also be compromised by those early decisions. In interviews Quantum Health conducted with cancer survivors, roughly half expressed dissatisfaction with the doctor they’d selected in that brief window and wished they’d had the support to make a more informed choice. 

What’s the solution to this unacceptable trade-off between the risks of delay and the potential costs of haste? The answer is to get inside that window with the data and decision-support to positively influence the trajectory of care.

Human-centered intervention and support

When Quantum Health set about designing a comprehensive cancer care navigation solution to tackle this challenge, we spoke with cancer survivors to understand their needs at the start of and throughout their journeys. Approaches to cancer care navigation often over-index on trend deflection and cost reduction at the expense of member experience. This results in well-meaning, but cookie-cutter solutions that fail to address real-world gaps and member needs. Any comprehensive, end-to-end solution needs the following capabilities for intervention and support.

Early detection and outreach

Priority one is being able to identify and reach out to members proactively, ideally before critical treatment decisions are even made. Through Quantum Health’s Real-Time Intercept ® capabilities and predictive modeling, we’re able to flag the start of a cancer journey to intervene ideally in the pre-diagnosis window – long before a claim is filed – based on signals like biopsies and MRIs, natural language processing (NLP) of provider interactions and more. This capability is critical because it allows us to get the wheels of the member’s journey on the right track from the outset.

A trusted guide

In our interviews, we consistently heard that patients felt overwhelmed and very unprepared from the start of their cancer journeys. They wished they’d had a single point of contact who had been through this before. As soon as we identify a member who’s about to begin a cancer care journey, we assign them a dedicated oncology nurse who can be their trusted guide – preparing them for what’s to come, examining questions to ask their oncologist, explaining benefits and coordinating disability options,  screening for social determinants of health risk factors, and more. 

Expert medical review and a network of excellence

In recent years, cancer care has become vastly more personalized and specialized, making it virtually impossible for oncologists to stay up-to-date with guidelines for every subtype or share protocols on treatment options. Through our medical review service, we can help ensure a member’s diagnosis and treatment plan are validated from the start by a vetted specialist, along with connecting them through our Center of Excellence (COE) partner to the best provider for their condition in their geography. With studies showing that 88% of cancer patients have at least one other chronic condition, it’s also essential that any treatment plan centers on the member holistically and not just their cancer condition.

Wrap-around support for members and caregivers

The first thing a member receiving a cancer diagnosis thinks about is not their insurance benefits. They are wondering and worrying: Will I still be able to work? How can I support and manage my family? Will I be able to afford this care? They need the right emotional and social support along with the best medical care. Depending on their available transportation and financial resources, for example, they might need rides to and from chemotherapy appointments or assistance with legal documents. In interviews, survivors also spoke of the hidden burden on caregivers, who neglect their own well-being in order to care for a loved one. Any comprehensive solution must support caregivers and their needs as part of the member’s support system. 

End-to-end cancer care navigation: No longer a nice-to-have

Cancer now tops the list of most costly conditions for large employers, with members having 7x to 8x higher claims than those without cancer. Meanwhile, one in three cancer patients is misdiagnosed from the start, leading to worse outcomes, higher costs, and a more difficult experience for patients at every turn. The answer can’t be to act slower; neither members nor their employers can afford the high toll from delays. The only option is to act smarter and more proactively out of the gate to set the right trajectory for care and then support members every step of the way.