Problem: Cancer significantly affects Indiana’s health care costs, mortality rates and employee output. At the time of this project, approximately two in five state residents expected to develop cancer during their lifetime.1
1Indiana Cancer Consortium. (2015). Indiana Cancer Facts and Figures, 2015. Retrieved from http://indianacancer.org/indiana-cancer-facts-and-figures-2015/. As this link is no longer active, see instead https://www.in.gov/health/newsletters/medical-reference-materials/cancer-reports/
PSE Change Solution: Learning that indirect costs of cancer to employers include more than $100 billion in lost productiveness, the Indiana Cancer Consortium (ICC) examined the cost-effectiveness of preventive services, particularly breast, cervical and colorectal cancer screenings. The ICC developed a certification program that recognizes workplaces that implement policies supportive of cancer prevention, such as age- and risk-appropriate cancer screening and early detection. After strategic outreach to employers through the Employer Gold Standard (EGS) initiative, more than a dozen organizations have been awarded EGS certification.
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Problem
Cancer significantly affects Indiana’s health care costs, mortality rates and employee output, with approximately two in five state residents expected to develop cancer during their lifetime (Indiana Cancer Facts and Figures, 2015).
PSE Solution
The Indiana Cancer Consortium (ICC), the state’s only comprehensive cancer control coalition, developed a certification program that recognizes workplaces that implement policies supportive of cancer prevention, such as age- and risk-appropriate cancer screening and early detection, in order to lessen cancer’s effects in the workplace and reduce the burden of cancer across the state.
Actions/Results
Based on the Five Pillars, the ICC Employer Gold Standard (EGS) Initiative targeted Indiana employers such as health care providers, local health departments, universities, governmental agencies, health insurers, hospitals, nonprofit organizations, key partner organizations, trade organizations, organizations serving underserved populations, etc. The EGS is structured to recognize organizations with a wide range of full-time staff, including organizations with fewer than 10 staff members to over 750 employees.
As of February 7, 2018, more than 12 organizations have been awarded EGS certification, with several more currently in the application process. These organizations include hospital systems, nonprofit organizations, universities and governmental agencies. The ICC assessed the available data (Step 3: Assess) by launching a data-driven plan. The ICC discovered the following:
- Workplace interventions are a key way to reach adults at average risk for cancer screening that leads to prevention and early detection.
- Indiana employers control health insurance for wellness care for 59% of working adults and their dependents.
- Indirect costs of cancer to employers include an estimated $136 billion in lost productiveness across the state.
Success Factors and Key Questions Addressed
The ICC created a packet to promote the ICC EGS Initiative (Step 5: Promote), including data on financial burden of cancer on employers in the state to incentivize employers to participate. By weighing employers’ willingness to take part, the ICC was able to find possible barriers to participation and involve employers as active partners in the process. Additionally, participation in the program required membership in the ICC, which ensured the active engagement and involvement of partners and stakeholders to sustain their program. The promotion packet also included an assessment of the employers’ capacity to implement evidence-based cancer screening strategies, which was intended to tailor program implementation to fit the needs of employers in Indiana (Step 6: Implement).
What data were needed to support your position on the issue(s)?
The ICC identified data on the indirect costs of cancer, as well as the importance of interested employers, given their influence on health insurance coverage for working adults.
What kind of data did you obtain (qualitative, quantitative, peer-reviewed journals, trusted sources, etc.)?
The ICC researched the cost-effectiveness of preventive services, particularly breast, cervical and colorectal cancer screenings, and referenced the American Cancer Society’s 80% by 2018 Communications Guidebook on recommendations for evidence-based interventions. In addition, the ICC used data from the 2006 Employer Health Benefits Survey and the National Business Group on Health to examine employer-sponsored health coverage and indirect costs of cancer to employers, respectively.
The 2017 Employer Health Benefits showed 55% of workers nationally are covered by health plans offered by their employer (The Kaiser Family Foundation, 2017). According to the National Business Group on Health (as reported by BusinessWire), in 2010 the indirect costs of cancer to employers included an estimated $136 billion in lost productivity. It is also projected that the cost of cancer care will reach $173 billion by 2020. (CEO Roundtable on Cancer, n.d.). Additionally, for every employee without cancer, employers spend an average of $3,000 per year in direct medical costs. When an employee is diagnosed with cancer that number increases to an estimated $16,000 per year. (Barnett, Birnbaum, Cremieux, Fendrick, & Slavin, 2000).
Review of these data compelled the ICC to identify the workplace as the key way to reach average-risk, age-appropriate adults for screenings that lead to prevention and early detection of cancer.
Were data/evidence available regarding cost-benefit?
The ICC used data on indirect lost productivity costs due to cancer as a way to showcase the possible benefits of getting certified, such as a reduction in sick leave, workers’ compensation and disability management claims costs, productivity losses and overall health costs.
What were your SMART (specific, measurable, attainable, relevant and time-bound) goals and objectives?
The EGS Initiative strives to adhere to the goals of Healthy People 2020 and the National Colorectal Cancer Roundtable’s (NCCRT) 80% by 2018. Using 2016 Behavioral Risk Factor Surveillance System data for Indiana:
- Screened 64.6% of adults for colorectal cancer (Adults age 50-75 who have had a colonoscopy, flexible sigmoidoscopy, or blood stool test within the appropriate time frame)
- Screened 72.5% of females for breast cancer (50-75 years old who have had a mammogram in the past two years)
- Screened 74.9% of females for cervical cancer (21-65 who have had a pap test within the last three years)
To increase these screening rates, the EGS Initiative encourages organizations to set goals that would move them toward the Healthy People 2020 goals for breast and cervical cancers and the 80% by 2018 goal for colorectal cancer. Per the draft Indiana Cancer Control Plan 2018-2020, the target is 93% for cervical cancer screening and 81.1% for breast cancer screening in Indiana, which align with the Healthy People 2020 targets. This provides an 18.1% and 8.6% window for improvement, respectively. Achieving 80% screening for colorectal cancer would require a 15.4% increase in statewide screenings by 2018.
The EGS Committee established the following goals to accomplish by June 29, 2018:
- Make three new contacts with organizations every month by ICC communication channels, technical assistance calls and membership processes
- Task the ICC Regional Cancer Control Coalitions to recruit new employers for the EGS
- Enroll five new employers into the EGS
- Retain 100% of existing EGS members and share their success stories through ICC communication channels
Related Resources
To learn more about the initiative, visit the Employer Gold Standard Initiative web page. The CEO Gold Standard website provides more information about the Five Pillars.
REFERENCES
Barnett, A., Birnbaum, H., Cremieux, P., Fendrick, A. M., & Slavin, M. (2000). The costs of cancer to a major employer in the United States: A case-control analysis. American Journal of Managed Care, 6(11), 1243-1251.
BusinessWire. (2010). National business group on health launches major initiative to address cancer in the workplace. Retrieved from https://www.businesswire.com/news/home/20101216005036/en/National-Business-Group-Health-Launches-Major-Initiative
CEO Roundtable on Cancer. (n.d.). Why should business leaders care about cancer? Retrieved from https://www.cancergoldstandard.org/why-go-gold/why-should-business-leaders-care-about-cancer
Indiana Cancer Consortium. (2015). Indiana Cancer Facts and Figures, 2015. Retrieved from http://indianacancer.org/indiana-cancer-facts-and-figures-2015/. As this link is no longer active, see instead https://www.in.gov/health/newsletters/medical-reference-materials/cancer-reports/
Indiana State Department of Health. (2016). Behavioral Risk Factor Surveillance System. Retrieved from http://www.in.gov/isdh/25194.htm
The Kaiser Family Foundation and Health Research & Educational Trust. (2017). Employer Health Benefits 2017 Annual Survey. Retrieved from http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2017
Resources to Support Similar Evidence-Based Initiatives
Evidence-Based Cancer Control Programs
The Community Guide
What Works for Health