Fewer cancer diagnoses in first weeks of the pandemic imply increased spending on cancer treatment in the future

• Far fewer cancers are being diagnosed during the coronavirus pandemic, whether the decline shows up in screening mammograms and colonoscopies or in other tests ordered after troubling symptoms prompt a doctor’s visit, according to recent JAMA Network study profiled in Stat News.
• Compared to Quest’s baseline period from January 2019 through February 2020, during the period from March 1 through April 18, the mean weekly number of newly diagnosed cancer patients plunged 46.4% for all six types: breast, colorectal, lung, gastric, pancreatic, and esophageal, according to the same Stat News article.
• The biggest drop seen was 51.8% in breast cancer and the smallest decrease was 24.7% in pancreatic cancer, according to the report.

A recent JAMA Network study profiled in Stat News reveals that, “By almost every measure, far fewer cancers are being diagnosed during the coronavirus pandemic, whether the decline shows up in screening mammograms and colonoscopies or in other tests ordered after troubling symptoms prompt a doctor’s visit. Compared to Quest’s baseline period from January 2019 through February 2020, during the seven weeks from March 1 through April 18, the mean weekly number of newly diagnosed cancer patients plunged 46.4% for all six types: breast, colorectal, lung, gastric, pancreatic, and esophageal. The biggest drop was 51.8% in breast cancer and the smallest decrease was 24.7% in pancreatic cancer.”

Takeaway

A couple of thoughts here:

First, so this is a downside to virtual care … the patient needs to be physically present for testing for a lot of things (at the risk of stating the obvious). Or the provider needs to have redesigned its primary care workflow to make sure patients are receiving their recommended tests in a safe convenient manner to support a virtual workflow. This is particularly true for high-risk patients.

Innovative ways to make tests available

One example of what this might look like for select conditions comes from Humana. Humana is mailing over one million in-home colon cancer and diabetic management screening kits to Medicare Advantage and Medicaid members. The kits will provide access to preventative care that members may have put off during the COVID-19 pandemic.

Beyond caring for its members who Humana is at risk for (e.g. receives a capitated payment from either Medicare or the various states where it offers MCO products for its members — more on that in a second), this helps maintain scores on certain quality and performance measures that are important to its bottom line. Colorectal cancer screening and diabetes care are two of those measures. It also helps differentiate its health plans from competing products to attract senior enrollees. And it helps Humana manage its Medical Loss Ratio by catching conditions earlier when outcomes are likely to be better and the cost of treatment lower.

Second, there’s been an almost universal cry to point out that providers who participate in capitated models have financially weathered the COVID-19 pandemic better than those who are completely reliant on fee-for-service. That has been true this far, and we’ve certainly heard this from our members who own health plans. And it may be true that capitated providers will still be performing better financially 36 months after the pandemic. But I think we need to see what the final results are.

Let me be clear … I fully believe that providers need to migrate to alternative payment models that reward them for delivering high-quality, cost-efficient/effective care. Fee-for-service is not sustainable (anyone who tells you otherwise hasn’t looked at the federal deficit lately or what’s going on with state budgets). Full stop. But providers need the capabilities to manage risk, and they need to be in models that are financially sustainable. So if you weren’t ready before COVID, I’m not sure how you’re better positioned to do so just because your balance sheet is a whole lot lighter as this seems counter intuitive to me… .

Why good actuarial support is a must

And where I get nervous — particularly looking at data like this — is that there will be a reflexive migration into risk-based models that providers aren’t prepared for in response to the financial shock of the pandemic. And then then the delayed utilization will flush through the system with more, sicker patients seeking care for conditions that if caught earlier could have been managed more cost effectively with higher quality outcomes. And the utilization/morbidity won’t be picked up in historical claims data used to set benchmarks. So providers could end up upside down in risk-based arrangements with already weakened balance sheets if they’re not careful. Good actuarial support has always been important as you get into this space, but the increased risk due to delayed care makes it more important than ever to help think through these issues and develop risk mitigation plans.