An increase in the number of members with cancer diagnoses was noted in 2006. In order to support the needs of these members, it was recognized that a coordinated approach to oncology case management was required. A pilot oncology case management program was launched, whose enrollment targeted select large national groups. The program focused on the most common cancer diagnoses in Pennsylvania: Lung, Breast, Prostate, Urinary Bladder, and Colorectal cancers. The objectives of the program included member education, counseling, and resource coordination to improve the overall quality of life, decrease inappropriate ER utilization, and hospitalizations. Training covering oncology basics was provided for a select group of case managers in the pilot program.

In 2007, because the initial pilot was considered successful, it was decided to expand the oncology case management program to all group members and increase the selected diagnoses to include 16 cancers. Training was designed for the case management staff; and registered nurses and social workers to assist members with education of: common cancers and treatments, treatment of side effects, coping/psychosocial needs, hospice, end of life care and coordination care with the health care providers. The training was completed in September, 2008, and the program went live in October.

As a result of the program’s success, there has been an increased enrollment of members with cancer diagnoses. This has led to new concerns for the staff including:

• Learning to manage the stress surrounding a terminal disease.


• The impact of supporting and encouraging the member, family, and caregiver.


• An understanding of long-term survivorship issues.