Managing complex cancer care
Focus on patient welfare, client costs and dependant support
Our Case Manager, Debbie, had been case managing this claim for a member with a complex type of cancer since July 2015. It was evident from the beginning that the member found it too stressful to talk about his condition so his wife calls Debbie on a regular basis.
Debbie has supported his wife since the early stages of his treatment and over the last 3 years his disease has progressed to a point where his specialists are prescribing treatment that is not curative, but is aimed at extending his life expectancy.
Following completion of surgery and chemotherapy, the member had some additional treatment and developed complications which necessitated intravenous antibiotics. Debbie was able to facilitate home care for their delivery which meant the member didn’t have to travel to hospital on a daily basis.
Challenge
Healix were able to utilise their panel of experts to determine that the proposed treatment was clinically appropriate and it was subsequently authorised. In addition to supporting the member, Debbie was also keen to help the client control the growing costs associated with the case.
Debbie actively negotiated with the provider to attain an additional 15% discount on this treatment, with the associated savings running into thousands of pounds. At renewal, the client introduced a policy cap for cancer treatment, which has been challenging with such a complex claim.
Approach
The provision of the consultation notes prompted A&E to conduct a D-dimer test, which revealed blood clots in both lungs. The proactive measures taken by the virtual GP ensured timely, accurate diagnosis and enabled immediate intervention, potentially averting severe complications.
Outcome
Debbie actively negotiated with the provider to attain an additional 15% discount on this treatment, with the associated savings running into thousands of pounds. At renewal, the client introduced a policy cap for cancer treatment, which has been challenging with such a complex claim.
The renewal coincided with a deterioration in the member’s health and Debbie was able to direct the member to his local NHS for regularly required blood tests to alleviate the need to travel to London three times a week. This has had the added bonus of preserving funds for more complex treatment.
Debbie has also been able to direct the member towards a palliative care specialist for much needed mental health support and also their local hospice to make use of their advice service. This will also provide them with physical support when this is needed. Debbie regularly receives updates from his wife and spends time providing her with information about his treatment as well as supporting her through this difficult time.