V-BID is based on the simple principle of structuring health plans so that they incentivize effective interventions and disincentivize ineffective ones. This does two things: it improves outcomes and it reduces costs, which allows funding to be reallocated to support innovative new treatments.

The oncology landscape has transformed in the wake of the Covid-19 pandemic, and organizations acknowledge that cancer is now the leading factor driving employers’ health care costs.

1. Focus on employee wellbeing

Enhanced healthcare benefits are a powerful way of retaining and attracting the best people at a time of talent shortages. That is why MSD (known as Merck & Co. in the US and Canada) pilot focuses on employee wellbeing and is just one part of a broader strategic approach to supporting wellbeing that spans other priority areas, such as mental health.

2. Use data to identify the strengths and weaknesses of the current plan

MSD’s team painstakingly gathered data from a range of sources to build a full picture of its plan members, profiling their health risks and analysing expenditure associated with cancer. That work yielded insights into where to target high-value measures. In MSD’s case, that meant focusing on five major cancers: lung, breast, prostate, cervical and colorectal.

“We chose those cancers based on the incidence and prevalence of these diseases among our employees,” explains Kehan. “But also the fact that you can screen for them.” Screening is one of the highest-value interventions available.

Those five cancers accounted for more than half of MSD’s total cancer spend, so targeting them promised to maximize the pilot’s impact, both financially and in terms of access to quality care for employees – a true win-win for the company and its people.

3. Apply insights into high-value care to maximize value

Cancer costs are increasing fast for many employers because of rising numbers of cases, the emergence of new therapies, and widespread waste or inefficiency. The cost of this waste could total almost a trillion dollars across the US, according to some estimates because of factors such as pervasive over-testing or using expensive hospital-based care when cheaper home-based care would be equally appropriate.

While V-BID has been used in areas such as cardiovascular or musculoskeletal conditions, says Kehan, it has not been applied widely to cancer. “Cancer is very nuanced,” he says, “very personalised.”

But with access to clear data on cancer’s impact on its employees, MSD decided to tackle the challenge. To understand how V-BID could be applied to cancer, MSD examined how it has been used in other therapeutic areas; reviewed oncological evidence on the most effective treatments; and drew on the expertise of specialists such as Dr Mark Fendrick of the University of Michigan’s Center for Value-Based Insurance Design.

The resulting pilot has a simple, bold aim: “The right care, at the right time, in the right place, with the right outcome, at the right cost.” It provides employees with 100% coverage for screening on the five priority cancers, and MSD is working to encourage employees to take up those checks, aiming to achieve best-in-class screening rates that enable timely diagnosis.

4. Collaborate to broaden access and improve equity

MSD hopes that sharing the lessons it has drawn from the V-BID Oncology Pilot will help other employers to improve their employee healthcare plans and widen access to quality care.

“I came into this role five years ago, and every large employer I spoke to was really struggling with oncology,” says Kathryn McKeon, MSD’s Senior Corporate Account Executive and Global Market Access, Strategies & Affordability Solutions – US Employer Market.

Now, by sharing its insights with other stakeholders, MSD hopes to empower them with the knowledge that will help them with their own innovations.