In early 2021, Carrum Health and Memorial Sloan Kettering Cancer Center (MSK) announced a partnership to offer bundled cancer care to employers. After years of researching how health plans and employers struggle to control their oncology spend, this novel collaboration piqued my interest. To find out more, our team sat down with Greg Green at MSK and Christoph Dankert and Kristen Barlow at Carrum Health. Here's what I learned from those conversations.
The partnership will involve two types of bundles based on employee need
MSK and Carrum Health, a digital health company that connects employers and their employees to provider Centers of Excellence, will be rolling out their cancer bundles in spring 2021.
Guidance bundle: Realizing that not every employee can or needs to travel to MSK for their care, this option provides a virtual connection to MSK specialists for second opinions and guidance across treatment. This helps local oncologists better monitor patient progression or recurrence. Carrum Health's robust digital platform will enable coordination and communication across the MSK team, local cancer care team, and patient.
Once an employee is enrolled, the bundle will last for two years. For the employers, value comes from the thorough workup MSK will provide, including genetic testing when indicated and pathway-concordant care, which can decrease avoidable utilization and unnecessary costs.
Case in point: Across the country, only 10% of non-metastatic breast cancer patients receive surgery without chemotherapy or radiation therapy, despite growing evidence that many patients do not benefit from the additional treatment. In contrast, at MSK, due to their use of diagnostic testing, such as OncotypeDx, and clinical pathways, 20% of non-metastatic breast cancer patients receive surgery only.
Treatment bundle: For patients who can and should travel to MSK, this involves a two-year bundled price for any cancer-related care received at the center. There will be a limited number of bundles for each tumor type to account for variations in treatment. For example, there are breast bundles for employees receiving surgery, surgery plus radiation, surgery plus radiation plus chemo, and a specific consideration for HER2-positive breast cancer.
At the beginning of treatment, the appropriate bundle will kick in for each patient. Importantly, the bundles will only include cancer-related care so, unlike the Oncology Care Model, providers aren't on the hook for unrelated expenses. But in addition to treatment and drug costs, the bundle includes treatment-related complications, mental health services, and interdisciplinary follow up care provided by MSK.
There is also an option for a hybrid model in which employees may travel to MSK for surgery but then return home for their chemotherapy and/or radiation therapy. In this case, the employee would be enrolled in the guidance bundle plus excision surgery bundle.
The treatment bundle is currently limited to non-metastatic breast and thyroid primary cancers
Employees diagnosed with non-metastatic breast or thyroid cancer can take advantage of the treatment bundle. It needs to be their first primary cancer, and patients with certain conditions, such as End-Stage Renal Disease, HIV, and pregnancy, are not eligible. However, the remote guidance bundle is open to any cancer type.
For the treatment bundle, breast and thyroid were obvious places to start since both are very common in the privately insured population. There is also evidence of significant over-treatment in both disease states. As Carrum looks to expand this to additional tumor sites, cervical, colorectal, and melanoma are at the top of the list.
Enrolled employees get access to a dedicated case manager and digital health tools
If an employee is enrolled in the program, they get access to a Carrum Health case manager, who serves as their advocate across the two-year bundle as well as robust digital health tools, including an app. Carrum reports that use of their app is so high that only 10% of employees on average end up calling Carrum for help.
Carrum is also responsible for coordination between MSK and the local cancer care team and will help employees organize their travel to MSK if needed.
Partnership based on MSK and Carrum's aligned vision for high-value cancer care
Coincidentally, over the past few years, MSK and Carrum were independently working on the issue of providing high-value cancer care to employers. For over 5 years, employers have partnered with MSK through their employee benefits program, MSK Direct. MSK was looking to continue to provide the highest quality cancer care, but also align financial incentives while doing what's best for the patient. Simultaneously, Carrum was hearing interest from their employer partners in addressing their increasing oncology spend, which currently accounts for about 12% of total employer health spend each year, while ensuring high-quality care.
Despite an aligned vision, the complexities of this arrangement took a year and a half of energy and effort from both sides to finalize. My big question going into this discussion was, how was MSK able to understand their costs and the bundle prices that would be sustainable for them? That's no small feat for any procedure, let alone a complex treatment pathway for cancer. The short answer: It took about a year, a small team of analysts, consulting support to define the bundles, and a robust internal dataset.
What does it take for a cancer program to be a good fit for this type of partnership?
From Carrum's standpoint, MSK is an ideal partner to roll out this novel economic arrangement. MSK has conducted research showing the improved long-term survival of cancer patients treated at cancer-only hospitals and National Cancer Institute centers compared to other hospitals. Additionally, while we often hear complaints from health plans about these centers being more expensive on a per service basis, MSK was able to demonstrate that their total costs of care are lower due to their improved diagnostics, treatment planning, and appropriate utilization.
After they roll this out and make sure its delivering value to employers and employees, Carrum is interested in adding more Centers of Excellence to ensure as many employees as possible can benefit—and employers are lining up to join. As they evaluate potential new care partners, the most important qualities they'll look for include total costs of care, survival, adverse events, patient experience, and organizational willingness. Is your cancer program ready?
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