• New lung cancer screening guidelines. The changes from the American Cancer Society may not have an immediate effect on employer-sponsored plans, but it is a reminder to improve education surrounding screenings.
• Boosting screenings is beneficial to employers. Catching cancer earlier increases the chances of successful treatment, often means simpler and less expensive care, and can cut down on lost productivity.
• Screening education should be ongoing and targeted. Employers should encourage screenings throughout the year, not just during open enrollment. Removing employee barriers to accessing screenings is vital as well.
Updated guidelines from the American Cancer Society (ACS) have expanded the eligibility requirements for lung cancer screenings.
Although the impact of this change remains to be seen for employer-sponsored health plans, many employers may benefit from taking a fresh look at their methods for encouraging workers to be regularly screened for cancer.
Under the previous eligibility guidelines, lung cancer screening rates were as low as 1% in some states. Lung cancer mortality rates are close to the mortality rates for colon, rectal, pancreas and breast cancer combined.
The new ACS guidelines for lung cancer screenings:
- Expand the recommended age range for screenings from 55 to 74 to 50 to 80.
- Reduce the “pack-years” for those who should be screened from 30 to 20 (calculated by multiplying the number of packs smoked per day by the number of years an individual has smoked).
- Eliminate the previous recommendation of stopping screenings after 15 years of no smoking.
Guidelines from the U.S. Preventive Services Task Force (USPSTF), whose recommendations generally guide employers’ and insurers’ actions, mirror the first two points but still recommend that screenings are discontinued if someone has gone more than 15 years without smoking.
Employers’ coverage already includes much of the ACS guidelines, said Magda Rusinowski, vice president with Business Group on Health.
“Although non-HSA plans may consider changes for those who quit smoking more than 15 years ago, for HSA-qualified health plans, pre-deductible coverage of screenings or other items and services that would go beyond the current USPSTF recommendations may impact the covered person’s ability to contribute to the HSA,” she explained.
As companies wait to see if adjusted screening eligibility requirements follow from the USPSTF, there is still an opportunity to improve communication surrounding screenings.
Why Employers Should Encourage Cancer Screenings
Lung cancer and other types of cancers now are affecting younger populations, and older individuals are remaining in the workforce longer, expanding the age range of workers who could be affected by cancer, said Mary Kay O’Neill, MD, MBA, senior health consultant with MercerWell.
When accounting for healthcare expenses and lost productivity, the annual cost of cancer is more than $180 billion a year, according to a recent ACS analysis. Increased education about screenings can prompt more employees to seek them out, found a study of employees in Missouri by the Centers for Disease Control and Prevention.
“Early detection makes a significant difference in outcomes and the course of treatment and may result in a lower cost of treatment for payers,” Rusinowski said. “Early screenings for patients at risk for lung and other cancers are in everyone’s interest, in accordance with clinical guidelines.”
Tips for Boosting Screening Education
An effective employer communication strategy aimed toward increasing cancer screenings should be ongoing — only mentioning the topic once a year at open enrollment time is a surefire way for it to be ignored, O’Neill said.
Employers also should determine the reasons their workers are not being screened and implement what O’Neill calls a “barrier-dropping exercise.”
Those in white-collar, salaried or flexible positions often are more positioned to take several hours off during a workday to complete a screening. However, hourly employees in manufacturing, retail or restaurant work may not have that luxury.
Some workers may simply benefit from frequent reminders about the importance of screenings, while others may need information about resources and clinics in the area, and reassurance that they can be screened without losing pay.
“There are disparity issues with screenings,” O’Neill said. “We encourage employers to offer a way for people to get these screenings without being financially punished. Each company has their own workforce doing particular jobs, in different locations, with various levels of health literacy, so you should really stand in your people’s shoes and think about the actual barriers they have.”
Rusinowski noted that innovative moves that employers have made include providing coverage for newer, less-invasive screenings, and offering expanded coverage with no cost-sharing beyond the recommended age criteria.
Other options include:
- Informing employees that there are recent advances in treating lung cancer.
- Ensuring there is no confusion about what is covered under preventative care so that employees don’t receive surprise bills.
- Providing access to local resources and troubleshooting contact information for the insurance company.
In addition, employers should continue to spotlight smoking cessation resources; as with substance abuse and behavioral health issues, tobacco use has increased since the pandemic, O’Neill advised.
“As an employer, emphasizing the kinds of services that are helpful to an individual or family in terms of their health status, showing people that they have good support from their employer, that’s a great aspect of loyalty and the relationship a person has with their employer,” O’Neill said. “Demonstrating that ‘We know what you need and how it will help you, and we’ll help you cover it, find it or access it,’ is important.”
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