Health Plans’ Role in Closing Cancer Care Gaps, Reducing Costs, and Improving Outcomes at Every Step

Cancer continues to rank as one of the most vexing healthcare challenges, both in terms of its clinical complexity and its financial burden. For health plans, rising cancer care costs—coupled with the 8–9% annual increase in overall health plan expenses—are a growing concern. Employers are now looking to their health plan partners for innovative solutions to manage cancer’s wide-reaching impact.

While efforts often focus on reducing treatment expenses, these only address part of the issue. Significant opportunities lie in tackling gaps in care throughout the cancer journey—before, during, and after diagnosis. Bridging these gaps can lead to earlier interventions, better outcomes, and lower costs for both patients and health plans.

Where Gaps in Cancer Care Drive Costs

Cancer isn’t a single encounter; it’s a complex care journey that spans prevention, diagnosis, treatment, and survivorship. Along the way, care gaps—such as delays in screening, misaligned interventions, and lack of survivor support—can worsen patient outcomes and spiral costs. For example, diagnosing cancer one stage later due to delays between an abnormal screening result and diagnosis can increase first-year treatment costs by an average of $52,000 and significantly reduce survival rates.

To address these challenges, health plans should take a closer look at gaps in cancer care among their covered members and identify opportunities for intervention.

The Case for Early Detection: Why Screening Matters

Detecting cancer in its earliest stages is one of the most effective ways to save lives and control costs. For instance, treating stage I breast cancer costs $191,000 less annually than treating stage IV. Early detection also significantly increases survival rates, with patients diagnosed at stage I often having a 69% higher likelihood of five-year survival.

Despite these benefits, barriers to screening persist:

• Awareness Issues: Many members are unaware of their screening eligibility or how to access these services. Providers may also struggle to keep up with evolving guidelines, making it harder to operationalize effective screening programs.
• Logistical Challenges: Finding time for appointments, arranging transportation, or balancing work and family responsibilities often deters people from scheduling screenings. Over half of working-age adults report difficulty accessing preventive services.
• Social and Cultural Disparities: Economic, linguistic, and cultural factors often create additional hurdles. For example, individuals with incomes at or below the federal poverty level are 24% less likely to receive colorectal cancer screenings than those with higher incomes.

Improving access to evidence-based screening programs, addressing these barriers, and ensuring members are aware of their options can help prevent costly late-stage diagnoses.

Beyond Screening: Addressing Post-Diagnosis Gaps

Care gaps don’t disappear after screening. Members who receive abnormal results often face confusion about their next steps, leading to delayed diagnoses and advanced-stage cancers that are far more expensive to treat. Without proactive support, these delays can drive up costs and worsen health outcomes.

• Post-Screening Challenges: The average member waits 70 days between an abnormal screening result and treatment. Streamlined, coordinated care can help close this gap and prevent cancer progression during this critical window.
• Treatment Navigation: Cancer patients often juggle multiple appointments, providers, and treatment protocols. Without clear guidance, many experience delays or fail to access preferred, cost-effective providers. Claims-based oncology services often come too late—most claims data sources lag by six months.
• Survivorship Support: The journey doesn’t end with remission. Survivors face increased risks of recurrence and other chronic conditions, but support often disappears post-treatment. As a result, total healthcare costs for survivors can be three times higher than for other members.

Building a Better Model for Cancer Care

To close these gaps and improve outcomes, health plans need cancer care programs that are proactive, continuous, and accessible. This requires rethinking traditional approaches in favor of more comprehensive solutions.

Key Principles for Impactful Cancer Programs:

1. Expand Access to Care: Programs must address the diverse needs of all members, from providing at-home screening kits to offering multilingual resources. Greater accessibility leads to higher screening rates and earlier interventions.
2. Ensure Specialist Expertise: Virtual, on-demand access to cancer experts ensures members receive timely, evidence-based guidance no matter their location. This reduces delays and avoids costly missteps in care.
3. Prioritize Early Interventions: Comprehensive risk assessments can identify members with the highest likelihood of developing cancer, enabling earlier and more effective interventions. For example, catching lung cancer at stage I instead of stage IV can save $319,000 in treatment costs while improving survival rates by 88%.
4. Balance Cost and Quality: By guiding members toward high-value providers and ensuring adherence to clinical guidelines, health plans can reduce per-patient costs by $197,000 annually while maintaining or improving care quality.

A New Model: Color Health’s Virtual Cancer Clinic

Built in collaboration with the American Cancer Society, Color offers a first-of-its-kind Virtual Cancer Clinic, powered by a 50-state licensed team of cancer-focused clinical experts, including oncologists, genetic counselors, dieticians, and nurses. This comprehensive care model delivers proactive, evidence-based interventions—spanning early detection, treatment management, and survivorship—ensuring seamless, guideline-based cancer care wherever patients seek support.

We actively engage members, assess their cancer risk, and ensure they stay current with recommended screenings. If a member is diagnosed with cancer, we help them start treatment faster with complete diagnostic workups through Color’s copilot, developed with OpenAI. And with Color, members get access to a dedicated, cancer-expert team, assembled according to their individual care needs. Such teams include individuals such as clinical oncologists, oncology nurse navigators, registered dieticians, high-risk clinical experts, cancer survivorship-specialized clinicians, and care advocates.

By enabling timely, risk-based interventions at every step of the cancer journey, Color enables earlier detection, better treatment outcomes, successful transitions back to health, and a lower cost of care for every member.

Ready to bridge cancer care gaps? Visit www.color.com/health-plans or contact us at learnmore@color.com to learn how Color Health can help.