Program helps cancer patients through system

Case managers provide support, resources

An oncology program, launched in January by Cigna HealthCare, provides members with cancer support through diagnosis, treatment, and survival.

Patients who are enrolled in the program receive assistance from Cigna case managers, who are trained in oncology care and who can help them navigate the health care system.

In addition, the Bloomfield, CT-based health plan has partnered with the Lance Armstrong Foundation, located in Austin, TX, to provide support and resources for people living with cancer.

The program builds on Cigna's previous core program of oncology case management, which focused primarily on members in active treatment for cancer with some kind of complication that occurred during their course of treatment, says David M. Ferriss, MD, MPH, medical officer for clinical program development for Cigna HealthCare.

"We saw an opportunity and a need to significantly expand the services we provide to members who have a diagnosis of cancer. The new program is a comprehensive program that goes far beyond the original program and includes a whole range of personalized services for people with cancer," Ferris says.

The program focus on all aspects of the disease from prevention to active treatment and survivorship, as well as working with members who need palliative or end-of-life care, he says.

The Institute of Medicine (IOM) has estimated that about half of all men and one-third of all women will develop cancer at some point in their life, Ferris points out.

Members eligible for the program are identified through claims data that may indicate they are being treated for cancer. Other members are identified through self-referral, through disability programs, or when a physician notifies the health plan of medical treatment for a member.

Once a member has been identified as being in active treatment for cancer, he or she is referred to Cigna's dedicated oncology case management team.

A case manager calls the members on the telephone, explains the program, makes them aware that they are eligible for the program, and enrolls members who are interested in participating.

The case manger conducts a telephonic assessment of the member's knowledge about cancer risk factors and overall health. During the assessment, the case managers gather details about the extent of the member's cancer, the member's treatment plan, and the stage in treatment.

The case managers help coordinate cancer patient care and eliminate potential gaps in care. Their support includes helping members better understand treatment options, helping them engage in effective pain and side effect management, educating them on how to best use their health benefits plan, and guiding them to find other resources that support them through treatment, recovery, and survivorship.

"Our goal is to reach these members very early so we will have an opportunity to supply them with the information they need to evaluate their treatment options, as opposed to identifying members when they are already locked into a particular course of therapy. We work to identify members as early in their course of treatment as possible," he says.

The case managers follow up with periodic telephone calls throughout the course of treatment. The number and frequency of calls the case manager makes depends on the needs and wishes of the individual member, Ferriss says.

The case managers help the members access information about their cancer through the Internet and often send them written materials.

Members in the program receive a toll-free number they can call to contact Cigna oncology case managers with questions and concerns.

"As much as possible, members work with a single oncology case manager who is familiar with the member's history and where they are in the course of treatment or survivorship. The case managers have the ability to share information so that if someone is on vacation or sick, another case manager has the information needed to assist the member," Ferriss says.

Members who have completed active treatment go into a lower stratification but will always have the option to call their case manager with questions or concerns, he says.

Members who have completed active treatment are contacted primarily through mail or e-mail but will always have the option to call their case manager with questions or concerns.

Members in the "surveillance category" have a past cancer diagnosis but are not in ongoing treatment. They receive regular mailings of educational materials aimed to reinforce healthy habits, including maintaining a healthy weight, exercising regularly, and eating a healthy diet.

For instance, women who have been treated for breast cancer but are not in any type of active treatment will receive messages about the importance of regular breast self-examinations and mammograms.

Members in the maintenance program have completed active treatment for cancer but may be receiving medication or other treatment for the residual effects. One example would be a woman with breast cancer who has completed chemotherapy and radiation but is taking an oral drug, such as tamoxifen, for a period of time.

The health plan mines its claims data to identify members who have access to the oncology program as part of their benefits and who have not had a regular screening for breast cancer, cervical cancer, or colorectal cancer. In those cases, the case manager reaches out to them to educate them on the importance of having the tests.

"We are taking it one step further by making proactive calls from case managers, trying to make the patients in the cancer case manager program aware of the benefits of regular screening," he says.

The program strives to support members who have completed their cancer treatment and face the challenges of life as a cancer survivor.

"When people have completed active treatment for cancer, we go beyond urging vigilance and monitoring to make sure there is no reoccurrence or that it is detected at the earliest possible stage. We make sure our members are aware of all the resources pertinent to cancer survivorship," he says.

Members in the cancer case management program receive the Livestrong Survivorship Notebook from the Lance Armstrong Foundation free of charge. The notebook and other materials available through the foundation help individuals cope with the physical, emotional, and practical challenges of cancer.