- Care managers help patients understand specialty treatment options and offer ongoing support.
- They identify the most cost-effective specialty medications as well as appropriate and convenient sites of care.
- They partner with physicians and care professionals to ensure a seamless care experience.
For millions of people living with complex, chronic, and rare health conditions, getting the care they need can be challenging. From diagnosis to locating the right doctors to understanding treatment options and costs to ongoing support, patients need a partner on their health journey.
Powerful specialty medications are often an essential part of treatment for complex conditions, and they can extend and even save lives. However, the average annual cost of specialty drug therapy for a patient is 75 times higher than the average cost of non-specialty prescription drugs. Research also suggests that the location these medications are administered — in a hospital, in an infusion center, or at home, to name a few — can have an impact on costs.
At Cigna Healthcare, we have a dedicated team of care managers who work one-on-one with patients to understand their needs and conditions, and to help make treatment less daunting. Care managers offer a concierge-like service to eligible customers — proactively connecting them to our network of trusted physicians, convenient site-of-care options, and other support. The goal is to give patients a more guided experience and improve their health outcomes while lowering the costs associated with their care.
Below we look at some of the ways these dedicated care managers have partnered with patients on their health journeys. (Editor’s note: Names have been changed to protect patient confidentiality.)
Treating patients in the comfort of their own homes
The administration of a specialty infusion or injection is often a lengthy process that takes from 2 to 6 hours. While certain medications should be infused or injected in a health care setting — a physician’s office, a hospital setting, or in an infusion center — there are circumstances where the medication can be administered in the patient’s home, if clinically appropriate.
This was the case for John, who was diagnosed with a rare form of cancer called malignant neuroendocrine tumors. As part of his treatment plan, John was receiving an injection of Somatuline Depot every four weeks at a local hospital, but he often struggled with finding transportation. John’s care manager partnered with him and his doctor to arrange for a nurse from Accredo specialty pharmacy to administer the injections in John’s home. Moving to in-home injections is improving John’s medication adherence and his overall care experience while reducing the total costs of his treatment by almost $285,000 a year.
Another patient, Daniel, was prescribed injections of the specialty medication Neulasta, which is used to prevent infection after chemotherapy sessions. He received these injections at a local medical center, but found it difficult to travel to an appointment following a strenuous session of chemotherapy. His care manager helped arrange for the injections to be administered at home. Daniel’s wife, who is his sole caregiver, preferred to give the Neulasta injections to her husband after learning how to do so with the help of Daniel’s care manager. The couple has the option to get assistance from an Accredo nurse at any time. Receiving home care helped Daniel stay as comfortable as possible throughout his chemotherapy while reducing his treatment costs by almost $30,000 a year.
Less costly treatments help reduce stress
Cigna Healthcare care managers also partner with treating providers to help patients find effective pharmaceutical treatment options for the lowest available costs. In some cases, this could mean the use of biosimilars that have been approved as clinically equivalent alternatives to more expensive brand-name biologic medications.
For Janet, who is living with Crohn’s disease, a single dose of Remicade could cost from $3,000 to $12,000. Janet’s care manager worked with her physician to instead prescribe Inflectra — a clinically equivalent biosimilar that would be as effective as Remicade, at a fraction of the cost.
Additionally, the symptoms associated with Crohn’s disease — such as abdominal pain, diarrhea, and fatigue, to name a few — made it difficult and oftentimes uncomfortable for Janet to get to her treatment in a local infusion center, particularly during a flare-up. Her care manager arranged for an Accredo nurse to administer the drug in Janet’s home instead. By working with care managers to switch to biosimilars and optimizing the site of care based on unique individual needs, patients like Janet can reduce treatment costs while experiencing a comfortable, convenient, and effective health care experience.
Maintaining care with existing and new providers
Core to Cigna Healthcare’s approach to care is working closely with physicians so that they can continuously oversee the care of their patients. When treatment is needed, our care managers partner with the physicians and other in-network health care professionals to ensure a seamless transition of care with little to no interruptions.
For example, when Cigna Healthcare customer Alex was diagnosed with Fabry disease, her doctor ordered regular Fabrazyme infusions at a local hospital. A care manager located a more cost-effective, clinically appropriate ambulatory infusion center and collaborated with Alex, the doctor, and the center to swiftly arrange infusions at the new site of care. This reduced the total annual cost of treatment by over $320,000 while improving the experience for Alex. Specialized infusion centers provide patients with sources of comfort that aren’t available in a hospital setting — like private rooms, high-speed Wi-Fi, snacks, TVs, and even chairs for their guests. Alex’s doctor was so impressed that he started to refer other patients to the ambulatory infusion center.
These are just some examples of how Cigna Healthcare care managers can support patients in specialty treatment throughout their health journey. The care managers also offer behavioral, wellness, and nutritional services, as well as support and resources for caregivers through the Cigna Caregiver Bridge Program.
The Promise of Specialty Medicine
The success of specialty medications will depend on the ability of the health care system to effectively manage them.