Advanced care planning for employees with cancer

The rising cost of employee health care — especially for serious and complex illnesses like cancer — is a constant challenge. Advanced care planning (ACP) can play a role in managing health care costs while also improving outcomes.

A recent study led by Allegheny Health Network (AHN) offers insights into ACP and how it empowers active decision-making. When conducted prior to cancer surgery, ACP can improve the patient experience and reduce health care insurance utilization.

What is advanced care planning?

Advanced care planning is a proactive, structured process that helps individuals express their thoughts and preferences regarding future medical treatment. This includes decisions about pain management, palliative care, and life-sustaining measures, as well as the creation of ACP documents.

For employees with cancer that requires surgery, ACP ensures that medical care aligns with their wishes. In addition to better decision-making, ACP can also:

• Decrease anxiety and depression regarding surgical treatment.
• Help prepare the patient for all possible outcomes.
• Increase patient satisfaction and improve quality of life.
• Provide more control for the patient and their family.
• Reduce unnecessary and unwanted health care interventions.
• Support the use of hospice or palliative services if/when needed.
  

Barriers to advanced care planning

Emotional, financial, and family barriers can delay advanced care planning, as can an optimistic outlook on one’s severity of illness. Barriers to ACP also exist on the provider’s side but have improved slightly in recent years.

A study in the Journal of Clinical Oncology found that physicians had increased ACP services and billing over a five-year period.¹ However, the rate of ACP remained at a low 3.3% in 2021.

The highest increases were among hospice and palliative medicine providers, offering end-of-life care. ACP was also more likely in metropolitan areas versus rural communities.

Preoperative care planning for cancer patients

The AHN-led research study — published in Annals of Surgical Oncology² — looks at the role of ACP in cancer surgery, specifically. AHN is based in Pittsburgh and comprised of 14 hospitals in Western Pennsylvania and Western New York. The health network also has several Cancer Institute locations in and around Pittsburgh.

The study examined more than 5,400 AHN cancer patients who underwent surgery for potentially curable oncologic conditions from January 2015 to December 2021. The study did not include cancer patients who opted out of surgical intervention.

More than 8% of patients — almost triple the national rate — received advanced care planning for their cancer treatment.

Researchers found that:

• ACP was more common in older patients, aged 73 +/- 10 years.
• ACP was more common for those with multiple health conditions.
• Highest ACP utilization was in patients with liver or lung cancers.
• Patients with advanced-stage cancers were more likely to receive ACP.
• Breast cancer patients were the most likely to have ACP before surgery.
  

Reducing health care costs with advanced care planning

Researchers had a small sample of patients that offered direct cost comparison. Breast cancer patients who received ACP were compared against breast cancer patients who did not.

The results showed lower 30-day follow-up health care costs for those who had preoperative ACP versus those who did not. The average cost was almost $8,000 for patients receiving ACP, compared with about $10,000 for those that did not have ACP support.

Improving decision-making support for cancer patients

Underutilization of ACP is problematic given the possibility of functional impairment, surgical complications, and intensive postoperative care. AHN researchers indicate the need for additional study into the integration of ACP in cancer care and treatment.

Immediate recommendations from the study point to a multipronged strategy that include:

• Electronic medical record prompts to introduce ACP into patient conversations.
• Quality care measures and assessments that integrate ACP metrics.
• Specialized provider training to enhance communication skills.
• Standardized ACP protocols and screening tools.
  

Employee health benefits and cancer care

There are ACP advocates across the research, clinical, payer, and provider communities. Companies can also play a role in championing advanced care planning for their employees, especially those fighting cancer.

The Americans with Disabilities Act (ADA) considers cancer a disability.³ Employers must make accommodations that enable employees to continue working throughout their cancer journey. However, companies can go beyond that by discussing ACP integration with legal counsel and their benefits broker or consultant.

Why ACP belongs in an employee health benefits plan

Leaders can ensure that employees — or dependents — undergoing cancer surgery receive the right care for their personal situation. Advanced care planning is essential for patient education and informed decision-making, as well as overall quality of life. Supporting ACP for cancer and other critical illnesses can have positive impacts on a variety of factors:

Employee productivity and retention

The health of the individual employee or their family member is top priority. However, coworkers also need attention. Serious medical conditions among their peers (or peers’ families) can create stress. Advanced care planning can bring stability to the situation with established treatment choices, timelines, and continuity of care details. Coworkers and managers will know when the employee will be out and can make their own plans accordingly.

Employee health care cost management

Unplanned employee health care impacts and expenses can explode spending and cost projections. Advanced care planning can ensure deliberate choices for personalized care and treatment. ACP becomes essential in the case of a terminal diagnosis as it can reduce unwanted and avoidable medical interventions.

Whole person health

Advanced care planning should also include steps to care for the whole person, from mental well-being to nutritional health. ACP easily integrates with already available employee health care benefits wellness programs.

Learn more about ACP for employees facing serious health challenges and treatment decisions. Talk to your Highmark account manager or employee health insurance benefits broker or consultant.