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Sample Cases

Case Study

A Las Vegas based self-funded trucking company has roughly 23,500 insured members.   Health plan premiums have been rising for a decade, but a big increase arrives for 2013.   In looking over their data, their consultant recommends the plan authorize a comprehensive review of cancer management programs. 

The consultant started by evaluating the plan's current program, which consists of traditional case management.  The group size of 23,500 insured members would see 70 new cancer cases per year.  Out of the 70, only 16 will utilize traditional case management services, leaving the Plan with 54 unmanaged cancer cases.  That is 77% of their cancer members being treated without any supervision or guidance.   With no monitoring of the bulk of their cancer cases, this leaves the Plan at a great risk for unnecessary costs.

The reinsurer recommended INTERLINK's CancerCARE™ program as a solution, which was reviewed. The CancerCARE™ solution requires model cancer benefit language be inserted into the summary plan document, which is missing for this plan.    The benefit plan language incentivizes members to seek NCCN® evidence-based care, which eliminates over treatment, under treatment, and inconsistent treatment.    It is estimated that nearly 20% of cancers are misdiagnosed, and CancerCARE's specially  built  Pathology/DiagnosticCOE Network  will be used to test targeted  cancers  before treatments begin, saving  the plan hundreds of thousands of dollars of ineffective care.  Other program benefits are:  1) clinical trial resolution; 2) complicated care directed to national centers; 3) specialized cancer case management nurses; and, 4) management of cancers in the community that have never been monitored.   CancerCARE ™ offers the total solution.