A Conversation with Natalya Gertsik & Tommy Axford from PHM 

Cancer is a leading cost driver for employer health plans, making it crucial for organizations to have effective strategies in place to mitigate risks and improve outcomes for their workforce. 

In the latest episode of the Healthcare on the Rocks podcast, Jennifer and David welcomed two guests from PHM, Natalya Gertsik and Tommy Axford, to discuss innovative strategies for managing employee benefits, with a particular focus on cancer care. 

Below, you’ll find highlights and takeaways from their conversation. Ready to listen to the full episode? Click here.

The Struggle with Containing Cancer Costs

Natalya highlighted several reasons why employers struggle with containing costs related to cancer:

  • Rising Specialty Drug Costs: The cost of specialty drugs, including checkpoint inhibitors and cell therapies, continues to increase, making it crucial to use these treatments in the right patients at the right time
  • Innovation as a Double-Edged Sword: While innovation in cancer treatment is a positive development, it also poses challenges as providers struggle to keep up with the latest advancements, leading to low adoption of effective therapies and suboptimal care
  • Younger Populations Being Diagnosed: As the incidence of cancer grows in younger populations, it is directly impacting the workforce, making it essential for employers to prioritize screening and ensuring that employees receive the right treatment at the right time
  • Complexity of Cancer Types: Cancer is not a one-size-fits-all disease, and employers need partners who can handle various cancer types, including rare cancers that may appear on high-cost claimant reports
  • Inability to Action Data: While employers may have access to data that identifies cancer as a problem, they often struggle to translate that data into actionable steps and programs to address the issue

The Importance of Precision & Personalized Medicine

Natalya defined precision medicine as medical care designed to optimize therapeutic benefits based on molecular signatures, including DNA, RNA, proteins, and the immune environment

  • Precision medicine improves clinical outcomes by targeting the molecular drivers of the disease
  • This type of medicine requires expertise, infrastructure, and the right incentives, which are often lacking in the current healthcare system
PHM is working to deliver precision medicine to patients through a team of Ph.D. scientists who develop data-informed treatment plans, enabling patients to live longer and better lives.

She also introduced the concept of personalized medicine, which considers factors such as culture, socioeconomics, and psychological factors to tailor treatment to the patient's individual preferences and needs

  • Personalized medicine allows patients to retain control over their lives and make informed decisions about their care

The PHM Approach: People, Processes, & Support

Tommy outlined PHM's approach to supporting individuals facing cancer, which revolves around aligning the right people and processes to ensure optimal outcomes.

The People
  • Advanced Practice Clinicians with expertise in managing complex cancers
  • Ph.D.-level Research Scientists
  • Care Coordination Logistics Specialists
The Process
  • Immersion: Diving deep into the member's medical records and health risks to fully understand their care journey
  • Diagnosis: Further characterizing the disease through additional diagnostic testing and imaging to ensure an accurate diagnosis
  • Treatment Planning: Collaborating to determine the most appropriate treatment options based on the specific disease and the member's preferences
  • Implementation & Ongoing Monitoring: Supporting the member throughout the treatment plan, facilitating transitions, and monitoring for recurrence

Success Stories & Takeaways

Natalya shared the inspiring story of Ben, a husband, father, and grandfather diagnosed with stage 4B prostate cancer and given six months to a year to live. Through precision medicine and creative thinking, PHM enrolled Ben in a European clinical trial for a promising treatment not yet approved in the U.S. Ben's response was astounding, and he is still playing with his grandchildren eight years later.

Natalya and Tommy left the audience with valuable takeaways:

Tommy: "This gives brokers, consultants, and employers a tool in their toolkit that can help them make a dent in those high-cost claimants that they have struggled with for years and decades."
Natalya: "When you're thinking about that 5 percent [of the workforce] and how to help them, often you need to think differently about the solution and the partner you're choosing."

As employers grapple with the rising costs of cancer care, precision, and personalized medicine offer a data-driven approach that considers both the molecular drivers of the disease and the individual needs of the patient. 

By aligning the right people, processes, and support, PHM's Clear Cancer Care Management Solution empowers employers to transform cancer treatment for their workforce, improving clinical outcomes and mitigating financial risks.