1. Understand where resources could make the biggest difference

MSD’s pilot process started with building a clear picture of the impact of cancer among employees under the company’s existing healthcare plan. “We knew we needed to understand our cohort better,” says Brian Kehan, MSD’s Wellbeing Director, Benefits.

Kehan and his team wanted a better view of employees’ risk profiles for a range of cancers, and the expenditure associated with those cancers. Analysis revealed that 47% of MSD’s employees were at high risk of cancer (or had already been diagnosed with it). That is above average, says Kehan: “We tend to have a higher age cohort here compared with the Apples and Microsofts of this world, which have a lot of Millennials and young people working for them.”

In parallel, the team closely examined the company’s cancer spend. “Like any other company, we spend an incredible amount on our health benefits – more than $435m annually,” says Kehan. Oncology accounted for $28.9m, and rising – a trend faced by many companies. The findings were illuminating. “We had 442 members that had cancer at a cost of almost $15 million,” explains Kehan. Lung cancer among just 48 employees accounted for $7m.

2. Study your own data to identify opportunities to move from low-value to high-value care

To shift more funding into high-value interventions, it was critical to pinpoint ways of reducing unnecessary expenditure and low-value care, which may be costly but delivers relatively few health benefits.

Kathryn McKeon, Senior Corporate Account Executive and Global Market Access, Strategies & Affordability Solutions – US Employer Market, explains that MSD started with the Milliman Waste Calculator to identify potential opportunities. “It provides direction for reducing inefficiency in the system,” she says.

Conservative calculations indicated as much as $12m of waste in MSD’s health plan spending. “That level is not unusual for any large or medium-sized company,” says McKeon. Having a credible figure gave MSD a clear target: “We could look at taking that financial headroom and moving it over to oncology.”

3. Use data continuously to refine and evolve the plan

The pilot scheme will continue to evolve to reflect patient needs, says Brian Kehan – in part thanks to new dashboards that make scheme data more accessible than ever. “The dashboards help us to home in on where people are getting their care,” he says. “So, we will be able to see where we need to make changes to the plan.”

That will be critical as the impact of Covid-19 on screening and diagnosis becomes clearer. “In 2020, we saw this huge drop in screening rates and doctor visits,” explains Kehan. “Some people have missed their window of opportunity to get screened and diagnosed early.”

Data dashboards make scheme data more accessible than ever

4. Share data-based insights to help other organisations

The MSD team is actively reaching out to varied stakeholders to share what it has learned from developing the V-BID Oncology Pilot. One audience is policymakers at US federal and state level, where the ideas behind V-BID have attracted bipartisan interest. Another is employers who are wrestling with similar challenges, to help them improve care for their employees. “We really want to be a role model for other employers in our approach to V-BID cancer care,” says Kathy McKeon.

MSD’s approach demonstrates what is possible with a focus on high-value care and a clear picture based on robust data – and McKeon is confident others will benefit from what the company has learned: “This is an extraordinary template.”