As Dr. Edward Licitra of Astera Cancer Care describes it, when patients are first told that they have breast cancer, their world can “quickly begin to completely spin out of control.” How this emotionally-charged moment is managed upfront is just as important as all the other medical and treatment steps that follow in oncology care.

Dr. Licitra says that all too often, new patients find themselves overwhelmed when trying to process their new circumstances, understand their diagnosis, and consider the options they suddenly face. Adding to the anxiety are questions about insurance coverage and cost, who they can trust to help sort it all out and how quickly they can get the care they need.

“The traditional oncology practice doesn’t always respond to a cancer patient’s anxieties and needs in a holistic, patient-centered way, so we’ve worked with Horizon to build one that does,” said Dr. Licitra, whose community-based oncology practices are located throughout Central New Jersey.

Under a new model, rolled out in June of 2020, Astera Cancer Care is paid by Horizon to comprehensively manage cancer treatment and active recovery after therapy.

"We have the ability at every touchpoint to coordinate and deliver care for our patients across their entire journey," said Dr. Licitra. "When a woman with a suspicious mammogram or a lump identified on self-examination presents to our office, we have breast surgeons who can do the biopsy, and perform the most appropriate surgery, medical oncologists who can give the most advanced chemo or endocrine therapy and radiation oncologists who give use state-of-the-art radiation treatment, all tailored to the specific features present in the patient and with the engagement of the patient and her family in this important decision-making. Instead of paying for each individual service, Horizon pays us for comprehensive coordinated care, which allows our practice to concentrate on the patient and not on administrative activities.”

This episode of care model removes the silos that often frustrate the oncologist. With insurer and oncologist working together, patients get an advocate and navigator to usher them through their journey, step by step. Astera and Horizon continue to improve the model and are in the process of using it for other types of cancer. Dr. Licitra says “While the episode model began with breast cancer, Astera and their partner OneOncology, the national platform for independent community oncology practices, have since developed episode-based programs with Horizon for lung cancer, prostate cancer, colon and rectal cancers and multiple myeloma and have a number of additional programs which are soon to launch. Both Astera and Horizon are committed to improving cancer in New Jersey. “Our partnership with Horizon really highlights the opportunity to improve the patient experience,” Dr. Licitra said.

“Better outcomes and a better experience for our members is what we aim to achieve with this approach, which is part of our broader Episode of Care program,” added Dr. Steven Peskin, Horizon’s Executive Medical Director for Population Health and Transformation. “Horizon has 28 Episodes of Care and 15 for oncology, including six for breast cancer. We have had tremendous success working with doctors across multiple specialties to create these collaborative models. It is a great example of what happens when doctors and health insurers work together to put the patient at the center of their work.”

Innovating new models to treat breast cancer cannot come at a better time. In the U.S., breast cancer remains the most common cancer (after skin cancer) and the second leading cause of cancer death (next to lung cancer) among women.¹ One in eight will be diagnosed with breast cancer in her lifetime. Screening and early detection offer some of the best chances to effectively treat breast cancer. The American Cancer Society has recommended the following guidelines for women at average risk of breast cancer:

• Women between 40 and 44 have the option to start screening with a mammogram every year.
• Women 45 to 54 should get mammograms every year.
• Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.
• All women should understand what to expect when getting a mammogram for breast cancer screening – what the test can and cannot do.

If you have any questions or need assistance with scheduling a mammogram, talk to your primary care provider or give Horizon a call at 1-800-355-2583.

Fighting breast cancer on multiple fronts

In addition to pioneering better approaches to cancer care, such as the episode of care Horizon has with Astera, beating cancer requires a wide scope of efforts to prevent, treat, research and attack the disease. Here are three other ways Horizon is taking the fight to breast cancer:

Keeping you on track with screenings – Horizon reviews claim data to outreach to and remind members of when they are due for a breast cancer screening. Already this year, Horizon has outreached to over 140,000 members through phone calls, emails and postcards to remind members that they were due for their screenings.

Helping to research the best diagnostic tools – Horizon supports The WISDOM (Women Informed to Screen Depending on Measures of Risk) Study. The five-year study seeks to clarify the safest, most effective screening method for women, and Horizon is covering the cost for 5,000 members to participate.

Grassroots support – Horizon partners with non-profit organizations to fund key events to raise funds and awareness for breast cancer research, such as the American Cancer Society’s Making Strides Against Cancer Walks, and Susan G. Komen Foundation’s NJ fund-raising efforts.

1. American Cancer Society https://www.cancer.org/cancer/breast-cancer.html