1. CANCER IN THE WORKPLACE: HOW EMPLOYERS CAN HELP National Business Coalition on Health Webinar September 9, 2015 1

2. Balancing Work and Cancer: How Employers Can Help Kate Sweeney Executive Director Cancer and Careers

3. Cancer and Careers empowers and educates people with cancer to thrive in their work environment by providing expert advice, interactive tools and educational events. CancerAndCareers.org Publications in English and Spanish Job Search Tools & Resume Review Accredited Programs for Healthcare Professionals CancerAndCareers.org/es Balancing Work & Cancer Webinars Community Events National and Regional Conferences CANCER AND CAREERS

4. RESEARCH: WORK & CANCER 41% of cancer survivors are diagnosed at “working age” (Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011 Jan 19;103(2): 117-28. Epub 2011 Jan 12) Cancer survivors are more likely to be unemployed (JAMA 2009; 301(7):753-762) 20% of cancer survivors still report work limitations affected by cancer-related problems 1-5 years after diagnosis (Work & Cancer Survivors)

5. RESEARCH: BREAST CANCER IN THE WORKPLACE ObjectivesPartnersInitiative Understand attitudes and beliefs of working women with breast cancer Understand barriers women with both early and metastatic breast cancer face at work, or as they return to work Gain broad understanding from 3 perspectives: – Patient – Physician – Employer Raise awareness of the needs of women with breast cancer in the workforce Multi-Disciplinary Steering Committee: Cancer and Careers National Business Group on Health Triage Center Johns Hopkins Avon Foundation Cancer Care Sharsharet Young Survivors Coalition Commissioned Harris Poll to conduct the Supporting Workplace Conversations survey with: 1,002 women with breast cancer who have worked or looked for work since diagnosis; of these, 189 had metastatic disease 200 healthcare providers 102 employers, represented by human resources personnel A Story Half Told Initiative: Pfizer/Cancer and Careers/Harris Survey

6. KEY FINDINGS Taken together, these findings suggest a need for improved alignment and communications between patients, employers and HCPs The majority of breast cancer patients (77%), including 7 in 10 metastatic patients (70%), have felt that working aids their recovery, a view endorsed by virtually all oncologists (96%) and many employers (90%) While most employers (91%) reported that their organization is supportive of employees with serious health conditions such as breast cancer, there is a disparity between the supportive measures and benefits employers report they provide and what women with breast cancer report are available Majority of women with breast cancer (70%) who work want to do so even while undergoing treatment; Greater support and communication from employers and healthcare professionals may help women with breast cancer thrive in the workplace Many patients (48%) reported that breast cancer and its treatments have negatively impacted their work life

7. Information on company policy –Medical leave policy –Short-term and long-term disability –Health Insurance –Flexible work policy –PTO, leave banks (if applicable) Applicable laws –Federal (ADA, FMLA, HIPPA) –State How situations like this have been handled in the past WHAT SHOULD I KNOW?

8. "I am sorry this is happening to you.“ "I don't know what to say or how to say it, but I do want you to know I am here for you." "Don't worry about work.“ "I am thinking of you.“ "How are you feeling today?“ "May I email you?“ "Wasn’t that a productive meeting?" WHAT SHOULD I SAY TO MY EMPLOYEE?

9. "I know how you feel.“ "My brother had this kind of cancer and he was in the hospital for months.“ "I know this will turn out OK.“ "The same thing happened to my neighbor, and it worked out fine.“ "Did you drink?“ or "Do you smoke?" Remember: Don't let talk about the cancer dominate every conversation. WHAT SHOULDN’T I SAY TO MY EMPLOYEE?

10. Information on company policy –Medical leave policy –Short-term and long-term disability –Health Insurance –Flexible work policy –PTO, leave banks (if applicable) Introductions to EAP/Insurance providers Cancerandcareers.org WHAT INFORMATION CAN I PROVIDE TO HELP MY EMPLOYEE?

11. Point person Creating a written plan Regular email wrap-ups or phone calls Online document sharing programs Keep employee visible WHAT ARE SOME GOOD COMMUNICATION STRATEGIES?

12. Flex time Telecommuting Part Time Equipment WHAT ARE SOME FLEXIBLE WORK OPTIONS?

13. Do one thing at a time Clear away clutter Make a list and prioritize it Turn off phone and email Take a walk around the block WHAT CAN I SUGGEST WHEN MY EMPLOYEE IS STRUGGLING TO STAY FOCUSED?

14. Pain Hair Loss “Chemo Brain” Fatigue Weight Changes Skin Changes WHAT ARE SOME COMMON SIDE EFFECTS MY EMPLOYEE MIGHT BE STRUGGLING WITH?

15. Manipulate Work Space  Phone, fax, files within easy reach  Switching offices  Special furniture requests HOW CAN I MAKE SURE MY EMPLOYEE IS COMFORTABLE?

16. WORKPLACE TRANSITIONS FOR PEOPLE TOUCHED BY CANCER Free eToolkit for Employers  Program developed by Cancer and Careers, The US Business Leadership Network, Pfizer, Anthem and SEDL (a non-profit research firm)  Piloted by Ernst & Young, Merck, North American Mission Board, Northrop Grumman, Verizon and Anthem  93% of managers reported finding this resource helpful, especially in helping them provide employees emotional support  86% of managers reported finding this resource easy to access and use  Available via www.workplacetransitions.orgwww.workplacetransitions.org

17. WorkplaceTransitions.org

18. CANCER IN THE WORKPLACE: HOW EMPLOYERS CAN HELP Lynn Zonakis Principal, The Zonakis Group LLC September 9, 2015

19. Agenda 19  Employer specific strategies for managing cancer in the workplace highlighting Delta Air Lines’ approach  Why a focus on cancer is important  Employer Toolkit on Cancer Treatment and Prevention  Importance of employee communications 19

20. 20 Why a Focus on Cancer is Important: The experience at Delta  Always in top three for trend and highest cost conditions  25% of high cost claimant expense and 16% of overall health plans cost attributable to cancer  Cancer pharmacy spend is over 15% of total pharmacy spend  Breast cancer is number one cancer cost and prevalence

21. Cancer in the Workplace: An Employer’s Toolkit on Cancer Treatment and Prevention

22. 22 The Toolkit – Overview Tool 1 – Quick Reference Guide: A brief summary of benefit and program recommendations across the benefit continuum. Tool 2 – Employer Benefit Design and Assessment: Provides practice recommendations and suggestions for comprehensive benefits, along with a methodology employers can use to assess their current benefits.  Tools include recommendations related to medical and pharmacy benefits, short-term disability, family medical leave and employee assistance programs and health improvement. Tool 3 – RFP and Proposal Scoring Tools: Resources to support implementation of recommendations from Tool 2. Tool 4 – SPD Guidance: Offers guidance to help employers translate the recommended benefit or practice into summary plan description language for beneficiaries. Tool 5 – Vendor Contracting and Administration Tool 6 – Vendor and Program Evaluation

23. 23 Sample of Benefit Recommendations  Reasonable out-of-pocket thresholds should be established so that cost is not a significant barrier for patients to obtain their medications. (Max of $100 per script and aggregate $200 per month)  Delta Air Lines’ approach  Benefit plan should establish parity of patient cost-sharing between the medical and pharmacy benefits.  Delta Air Lines’ approach  Benefit plan should include hospice coverage for individuals with an estimated life expectancy of 12 months or less to live if their disease runs its usual course.  Delta Air Lines’ approach  Benefit plan should have appropriate time off and leave provisions that support the employee with cancer  Delta Air Lines’ approach

24. 24 www.businessgrouphealth.org/cancer Click on “All Cancer Resources” at top of the page. To Access the Tools:

25. Delta Air Lines’ Initiatives to Support Cancer Patients: Programs & Communications

26. 26 Prevention Managing cancer starts with prevention and early detection  Preventive care is important in order to maintain a healthy workforce – strongly supported by our leadership team  Delta provides 100 percent coverage for recommended cancer screenings  Has been in place for many years, well before the requirement by the ACA

27. 27 Support – Delta Health Direct A confidential, concierge total population management healthcare program. Services include NurseLine, treatment decision support, wellness coaching, complex case/disease management and more. The Cancer Resource Services/Support program is part of Delta Health Direct. There are two dedicated cancer nurses available to work one-on-one with employees and/or their eligible family members.

28. 28 Cancer Resource Services / Support Telephonic case management program delivery model.  On-going case management delivered by experienced cancer nurse with 10-15 years of oncology experience, throughout treatment, survivorship, or through end of life  Treatment plan created from initial assessment; each call has specific goals around right care, right provider, right lifestyle, right medication  For patients in active cancer treatment  Common and complex cancers  Adult and pediatric patients

29. 29 Value Throughout the Care Continuum Laboratory Pathology Radiology Surgery Radiation Transplant Chemotherapy Medication Radiation Chemotherapy Medication Radiation Chemotherapy Pain management Palliative care Advanced illness care Help patients confirm diagnosis at COE or through other vendors Option for second opinion at COE or other Help patient understand diagnosis and potential treatment options Guide patients to appropriate providers Confirm treatment plan Option for specialized physician review Option for second opinion at COE or other Confirm goals of treatment (curative) Confirm treatment plan Educate patient on importance of adhering to treatment plan Manage high cost medications Confirm member has symptom control meds Member understands when to use ER Manage systems and side-effects to prevent unnecessary hospitalizations Access to support (behavioral, social worker, other) Confirm goals of treatment (palliative) Confirm treatment plan Educate patient on importance of adhering to treatment plan Manage high-cost medications Confirm member has symptom control meds on-going pain mgmt Member understands when to use ER Manage systems and side-effects to prevent unnecessary hospitalizations Access support (behavioral, social worker, other) Decision support around end of life –Discuss patient goals and desires –Help patient communi- cate to family and caregivers Care in the most appropriate setting Pain management Manage symptoms and side-effects to prevent unnecessary hospitalizations Behavioral support Social worker support DiagnosisTreatmentAdjuvant therapyEnd of Life Recurrent metastatic Cancer Support Program

30. 30 Cancer Centers of Excellence Program  Approximately 30 facilities nationwide specializing in various types of cancer  Dedicated cancer nurse through the Cancer Resource Services / Support program can assist in arranging care at a COE  Travel & Lodging Benefit  $10,000 for employee and one family member  Enhanced coinsurance benefit

31. 31 Communication  Quarterly newsletters – home mailing and online  Monthly Healthflyers – online  Intranet information  E-mails  Health fairs  Referrals from HR and Leaders  Referrals from Delta Health Direct and other service providers including UnitedHealthCare, disability vendor, etc.  Employee Testimonials