At Kathy's* annual wellness visit, her primary care provider (PCP) asked her qualifying questions for a low-dose chest CT to screen for lung cancer due to her history of smoking. Based on her answers, Kathy’s PCP suggested and ordered the CT.
Kathy scheduled the CT at the local hospital, but she worried that the CT was too expensive; due to her high-deductible plan, Kathy’s out-of-pocket cost would be $2,725.00. Further, she was frustrated about having to use her time off for a hospital visit. As a result, Kathy did not undergo the CT.
Diagnosing Kathy
Kathy’s CT showed a 6 mm nodule, so her PCP recommended a diagnostic scan followed by a biopsy.
Stage 1 non-small cell lung cancer (NSCLC) was confirmed and successfully treated with surgery alone. Kathy required no additional intervention.
Making the right call
Preventive Care can improve outcomes
Earlier-stage lung cancer is associated with higher survival rates. In Kathy’s form of lung cancer, the five-year survival rate is stage 4 disease is only 9%, while for Stage 1 disease it is 90%.
Since less treatment is needed, costs are also lower with earlier-stage lung cancer. The first year of treatment for stage 4 disease can be more than three times higher than for stage 1 disease.
Adherence to preventive care and cancer screening programs is critical for patient health, as well as health plan and provider performance. However, patient outreach presents an added challenge for busy providers. EviCore’s Preventive Care Outreach program operates as a seamless extension of our partner health plans to benefit their members and deliver an exceptional experience.
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*Not patient’s real name. Images are for illustration purposes only.
Kathy’s journey with preventive care support
The result: Better health outcomes and lower costs for everyone.
Learn more at EviCore.com
Meet Kathy
Kathy’s journey without preventive care support
Kathy’s journey without preventive care support
Two years later, Kathy is in remission. The EviCore Preventive Care Outreach team regularly checks in with her to ensure she is getting her annual cancer screenings (i.e., mammograms, colonoscopies and Pap smears).
Outcome
Due to the high out of pocket cost of the CT and the need for her to take time off from work, Kathy did not undergo the CT.
The journey with no preventive care support
The EviCore by Evernorth® Preventive Care team received Kathy's information from her health plan. They reached out to her to understand on a one-on-one level why she didn’t complete her CT. During the conversation, the EviCore agent identified the barriers as cost and time.
The agent was able to find Kathy a nearby in-network location where her out-of-pocket cost for the CT would be $250. This location also offered appointments on Saturday mornings. With her consent, the EviCore agent scheduled Kathy’s appointment and coordinated the CT order and prior authorization.
Because there was no claim for the chest CT six months after her PCP submitted the order for it, Kathy’s health plan identified her as someone who would benefit from outreach.
The journey with preventive care support
The EviCore by Evernorth® Preventive Care team received Kathy's information from her health plan. They reached out to her to understand on a one-on-one level why she didn’t complete her CT. During the conversation, the EviCore agent identified the barriers as cost and time.
The agent was able to find Kathy a nearby in-network location where her out-of-pocket cost for the CT would be $250. This location also offered appointments on Saturday mornings. With her consent, the EviCore agent scheduled Kathy’s appointment and coordinated the CT order and prior authorization.
Kathy receives outreach support
Kathy’s journey with preventive care support
Further diagnostic imaging and a biopsy found that Kathy had Stage 4 non-small cell lung cancer (NSCLC). Over the next two years, she underwent multiple rounds of chemotherapy, immunotherapy and radiation therapy, which were unsuccessful in controlling the spread of her cancer.
Kathy learned that Stage 4 NSCLC has a five-year survival rate of just 9%.
Adherence to preventive care and cancer screening programs is critical for patient health, as well as health plan and provider performance. However, patient outreach presents an added challenge for busy providers. EviCore’s Preventive Care Outreach program operates as a seamless extension of our partner health plans to benefit their members and deliver an exceptional experience.
The result: Better health outcomes and lower costs for everyone.
Preventive Care can improve outcomes
Two years later, Kathy developed an acute cough. Her provider noticed she still hadn’t had the CT, but a chest X-ray done that day showed a 4 cm mass in her lung.
Learn more at EviCore.com
Because her plan did not include EviCore Preventive Care team, there was no outreach to go over her decision and find potential solutions.
