Employer-Based Disease Management Programs in Cancer: Experience to Date
Frederick C. Lee
The cancer disease management field took root in the early 1990s. Health plans in the US seeking to aggressively manage cancer reached out to entrepreneurial start-ups that had infused the general principles of managed care into cancer programs. More than two dozen health plans had adopted some form of cancer disease management by the end of the century. However, employers, witnessing the managed care backlash and experiencing difficulty recruiting an adequate pool of skilled labor during flush economic times, have abstained from aggressive management of their workforces Employers, unlike health plans, pay for work loss associated with disability and absenteeism. Hence, the per capita cost of cancer to employers greatly exceeds that of health plans. As the US economy soured in 2000 and healthcare premiums grew at double-digit rates, employers began to abandon their previous reluctance in adopting disease-specific programs. Some employer initiatives to date are not fully-fledged cancer disease management programs; rather, pieces of such programs have been introduced. The return on investment achievable by implementing a comprehensive cancer disease management program, once known to employers and their consultants, will likely spur much greater adoption of such programs in the next 5 years. This review highlights piecemeal efforts where employers have adopted a form of cancer disease management. Attention is given to some of the employer costs associated with cancer, suggesting that greater awareness of the exposure and potential upside will likely result in more employers embracing fully-fledged cancer disease management.
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