Employers Want More From Their Health Plans for Cancer—Here’s What That Looks Like and How It Drives Down Costs

Othman Laraki, CEO, Color Health

Cancer rates are rising among working-age populations, and employers are feeling the burden. Eighty percent of employers rank cancer among their top health care cost drivers. As more people under 65 years are diagnosed—especially women under 50 years—employers can expect a greater impact on their workforce and even higher costs. They’ve traditionally turned to their health plans to help manage cancer’s clinical and cost impact on their workforce. That approach is no longer cutting it. A recent survey of human resources (HR) and benefits leaders found that 72% of employers feel their health plans aren’t getting enough employees screened. Seventy-five percent acknowledged limitations in their health plans’ cancer offerings and a need for more support to effectively address cancer in their population.

The directive is clear: employers are asking for more from their health plans when it comes to cancer. With health plan costs rising up to 9% year over year, plans should also rethink their cancer strategies to intercept coming hits to their own finances. While many use tools like the Healthcare Effectiveness Data and Information Set (HEDIS) to measure and maintain cancer screening in their populations today, it’s not always clear what more they can do to control cancer’s impact on their populations.

By investing in earlier interventions and full-spectrum support across the cancer care continuum, health plans can drive better outcomes for employers while decreasing costs. There are countless opportunities for better-managed care to lower total costs: diagnosing cancer just 1 stage earlier can save $63 000 per patient and triple 5-year survival rates. Yet 7 in 10 adults in the US are currently out of date with at least 1 cancer screening. During active treatment and survivorship, effectively managing the effects of medications can prevent about half of costly emergency department visits, saving tens of thousands of dollars on unnecessary visits and admissions while avoiding suffering for patients.

Health plans may face difficulties managing cancer’s impact on employers and members today, but end-to-end cancer programs—spanning early detection, diagnosis, treatment, and survivorship—can deliver the proactive interventions needed to keep costs down and keep members healthier.

Employers’ and Health Plans’ Cancer Challenges

Health plans and employers currently focus much of their cancer-related efforts on reducing treatment costs. It’s an intuitive place to start, as the US spends over $200 billion on cancer treatments each year. But cancer is more than 1 event to be managed. We can’t hope to make a dent on the total cost of care by addressing just 1 step of the cancer journey.

There is growing recognition among employers of the importance of full-spectrum cancer care. In the aforementioned survey of HR and benefits leaders, 91% of employers feel their company should not only focus on clinical management of active cancer cases but also early detection and survivorship support. Additionally, 95% agreed that earlier detection of cancer is one of the most effective ways to improve employee health outcomes and reduce cancer-related costs. Many, however, have struggled to put those ambitions into practice.

Despite screening guidelines from the American Cancer Society (ACS), United States Preventive Services Task Force (USPSTF), and National Comprehensive Cancer Network (NCCN), as well as coverage from health plans for routine cancer screenings, many barriers hinder preventive care. People may not be aware of their hereditary cancer risk, for example, and how that influences their screening eligibility. Challenges scheduling appointments for screenings or follow-up care, or fear associated with the potential of hearing “you have cancer”—not only for healthy individuals, but also for survivors at increased risk of cancer recurrence—prevent some from seeking care at all.

On the provider’s side, frequently changing clinical and diagnostic guidelines make it difficult to keep up with the latest recommendations for diagnosing and treating cancer. Not only can this delay care, but it also risks patients receiving outdated interventions. The impact of these missteps can mean crucial time and thousands of dollars wasted per patient. This hurts all parties involved—the patient, the provider, the employer, and the health plan.

How Health Plans Can Meet Employers’ Cancer Needs

Health plans’ strategy for controlling cancer must prioritize both early detection and full-spectrum care. Rather than trying to implement these changes via an already overburdened clinical workforce, health plans can offer dedicated cancer programs to employers that bring end-to-end cancer services to entire workforce populations.

These programs facilitate early detection through risk assessments and personalized screening plans that take into account the most up-to-date guidelines and individual needs. Coupled with accessible screenings—such as at-home testing options and logistical support for booking appointments—can help members get screened as efficiently and conveniently as possible, reducing high costs associated with late-stage diagnoses. A study of 1 end-to-end cancer program found that in 8 weeks, it had increased participants’ screening adherence by 2 to 3 times, including boosting lung cancer screening rates from 23% to 73%. This type of intervention is especially critical in lung cancer, where detecting disease at stage I versus stage IV can result in $319 000 in treatment cost savings and an 88% increase in 5-year survival rates. As only about half of eligible Americans are up-to-date with lung cancer screening today—a result of a lack of awareness of screening guidelines, stigma associated with disclosing one’s smoking history to their doctor, and other factors—improving screening rates could make a significant impact on costs and outcomes.

If an abnormal result is discovered and a diagnosis is made, expert-led cancer programs provide the support needed to ensure the right course of additional testing and treatment while helping people navigate the complexities of cancer care and mitigating any health issues before they progress. These programs can help providers interpret the latest clinical guidelines and ensure people have completed all the necessary tests before they meet with their oncologist. During treatment, they can guide people to in-network providers and take direct action to manage treatment complications early. Once a member enters recovery and shifts from oncologist-led to primary care-led treatment, these cancer programs focus on mitigating their risk of cancer recurrence. They provide updated screening guidance for survivors’ elevated risk of cancer and other late effects like cardiovascular complications, helping their primary care providers deliver the best care throughout survivorship and preventing severe symptoms or hospitalizations. In aggregate, each of these interventions contributes to tens of thousands of dollars saved for employers and health plans, and improved quality of life for members.

Without dedicated efforts from health plans to reduce the burden of cancer across the US, we’ll continue to see late-stage diagnoses devastate communities, businesses, and our economy. Through the programs they offer, health plans can deliver what employers need for their populations while reducing their own long-term costs. In the absence of a cure for cancer, these approaches are our best bet for controlling it.

About the Author

Othman Laraki is a technology entrepreneur, an investor, and the co-founder and CEO of Color Health. Othman was an early Product leader at Google, where he worked on performance infrastructure and client-side software, including the Google Chrome browser. After leaving Google, he co-founded MixerLabs, which was one of Twitter’s first acquisitions. At Twitter, Othman was the Vice President of Product, helping create the company’s first revenue products and grow the user base from 50 to 200 million users. After leaving Twitter, Othman co-founded Color Health, which he has been leading for the past ten years. Othman holds degrees in computer science and management from Stanford University and the Massachusetts Institute of Technology. He is a long-time investor and advisor to leading companies such as Pinterest, AngelList, Slack, Instacart, Gitlab, and others.