Does Your Health Plan Have an Effective Breast Cancer Care Program?

1. Do you have an aggressive and effective system to remind and encourage patients to receive important breast cancer screening?

Because there is no known way to prevent breast cancer early detection through mammography, clinical breast exam and self examination are the most critical lines of defense women have against the disease -- more than 90 percent of women whose cancer is detected and treated in its early stages are cancer-free after five years. Health plans must develop systems for ensuring that members know about and utilize breast cancer screening services.

2. Do you have a comprehensive tracking system to ensure that every patient's treatment progress is carefully monitored at all times?

Because breast cancer becomes increasingly serious as it progresses, "timeliness" is as important as "quality" when it comes to treatment. It is imperative that health plans develop safeguards to ensure that the full-range of breast cancer is delivered as quickly as possible and that no step in any patient's treatment falls through the cracks.

3. Do you have an effective tracking system to monitor physician practices?

Managed care plans are in a unique position to develop systems for tracking an individual physician's practices. This process allows doctors to compare the therapies they utilize to those used by others, and it provides a means for health plans to identify physicians whose practices fall outside established guidelines, better ensuring that all practitioners are utilizing the most up-to-date treatments and procedures.

4. Is your breast care center accredited by the American College of Radiology and certified by the U.S. Food & Drug Administration, and have all radiologists received advanced level mammography certification?

It is essential that mammography be of the highest possible quality. Effective mammography can discover a tumor up to two years before a doctor or patient would otherwise know it was there. Bu mammography can discover a tumor up to two years before a doctor or patient would otherwise know it was there. But mammography can fail to do its job due to poor technique in taking, processing or reading the films; inadequate record keeping and reporting of results; and lack of effective quality controls. The FDA has posted a list of certified breast care facilities in each state on its web site at http://www.fda.gov/cdrh/faclist.html.

5. Do you make breast care more accessible to low-income women by conducting community-based outreach?

It is critical that plans raise awareness about the importance of mammography and other breast care services and make them more accessible to women living in poverty. Breast Cancer runs across ethnic lines but death rates are much greater among women of low socioeconomic status, in part because the cancer is often detected at later stages when it is more aggressive and deadly. Health plans should build programs that consider key cultural and economic issues that might otherwise impede a program's effectiveness.

6. Do you provide breast cancer patients access to important mental and emotional support services?

As with any life-threatening disease women diagnosed with breast cancer are forced to face their own mortality and balance feelings of anger, depression and hope. But unlike most other illnesses, breast cancer also conjures up lifelong personal and societal issues surrounding femininity, sexuality and body image. It is important that health plans offer breast cancer patients the support they need to deal with the effects of the disease on their body, their mind, and their spirit.

7. Do you provide patients with a Breast Care Coordinator R.N. to offer additional support, helping them to evaluate treatment options, monitor treatment progress and identify additional services?

Beyond having to deal with the physical and emotional effects of the disease, women with breast cancer also have to make their way through complicated medical information and make tough decisions about treatment options. Most patients need help. Health plans should provide a designated staff person-such as a Breast Care Coordinator-to help women decipher information, track their treatment progress and offer general support.

8. Do you supply breast cancer patients with important information in an easy to understand, culturally appropriate format?

In order to make informed choices about their health, women rely on their health care providers to supply information they can understand and use. It is important that health plans develop a standard set of materials that deal with the full-range of issues about which women with breast cancer must think and offer it in a variety of easy to use formats. It is also important that materials are written in the language and literacy level appropriate for the intended audience.

9. Do you gauge patient satisfaction and program effectiveness by conducting opinion surveys among patients with breast cancer?

It is important for health plans to explore additional methods for providing care to breast cancer patients. Plans are in a unique position to test the effectiveness of, and allow their members to take part in, supplementary programs. Often, these "extra" programs yield incredible results: For example, it has been proven that group psychotherapy programs work as an effective companion to medical therapies, and may even increase survival times.

10.  Do you invest in research programs to evaluate the effectiveness of pairing complementary therapies with traditional medical treatments?

One of the most important steps health plans can take to better serve women, is to ask them for their input. Too often, programs that seem worthwhile to health plan staff, actually provide little benefit to patients. Using patient satisfaction as a key means of measuring the success of a program will help health plans provide more comprehensive service to breast cancer patients. 

The main source of information for this section, the tips, and the decision-making guide is from the Breast Buddy Volunteer Curriculum © 1994.

* Source: Adapted from The American Association of Health Plans (AAHP)
"Best Practices in Women's Health" ©AAHP 1998. Reprinted with permission from AAHP.

Last Updated: 06/01/2004