Cancer Care Is Too Important to Leave on Autopilot
For self-funded employers, a reactive approach to cancer claims is not a strategy. Building proactive support around members — oncology navigation, second opinions, centers of excellence, specialty pharmacy oversight — protects the plan while delivering better care.
VP of Employee Benefits · BHC Insurance · Independent Benefits Consultant
Cancer care is a critical area that self-funded employers must prioritize. It is also one of the most challenging aspects of health plan management. The complexity arises not only from the significant costs involved but also from the reality that each cancer claim represents an individual facing a profoundly difficult time in their life. This reality shifts the focus from merely reducing expenses to ensuring that individuals receive the right care and support as swiftly as possible.
The problem with a reactive approach
Currently, many health plans adopt a reactive approach to cancer care. A diagnosis occurs, a treatment plan is set, claims begin to roll in, and employers are left to decipher the situation after the fact. For self-funded employers, this is not an effective strategy. By the time the data surfaces in a claims report, the decisions that drive the largest costs have already been made — often without the oversight or coordination that could have changed the outcome.
What a proactive approach looks like
A more proactive approach involves building support around members earlier in the process. This can encompass oncology navigation, second opinions, centers of excellence, genetic testing guidance, specialty pharmacy oversight, site-of-care review, biosimilar evaluation, and enhanced coordination between the medical and pharmacy components of the plan. These strategies aim to simplify the process for individuals already facing significant challenges. When implemented correctly, they should facilitate navigation, prevent unnecessary delays, and connect employees with experts who can confirm diagnoses and treatment paths. They should also assist families in understanding their options during overwhelming times.
"Effective plan management and compassionate care can work in harmony. When patients receive the right diagnosis, treatment plan, and guidance, it benefits everyone involved."
Effective plan management and compassionate care are not in conflict
Effective plan management and compassionate care can work in harmony. When patients receive the appropriate diagnosis, treatment plan, medication, and guidance, it benefits everyone involved. Members gain better support, and employers can reduce waste, avoid inappropriate care, and effectively manage one of the most intricate areas of health plan administration. This is not about cutting corners on care. It is about making sure the right care is delivered in the right setting by the right providers — and that the plan is not funding treatments that are duplicative, inappropriate, or avoidable.
The questions every self-funded employer should be asking
Cancer care is too vital to be left on autopilot. Self-funded employers must be aware of who is assisting members through the process, who is reviewing high-cost therapies, who is assessing site-of-care decisions, and who is coordinating efforts before claims become unmanageable. If the answer to any of those questions is 'no one' or 'I'm not sure,' that is worth addressing before the next high-cost diagnosis arrives. The objective should be clear: protect the plan while ensuring better care for those who rely on it.
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Sources & Further Reading
- American Cancer Society: Cancer Facts & Figures 2024 — Incidence and mortality data establishing cancer as a leading driver of catastrophic claims in employer health plans.
- IQVIA: Global Oncology Trends 2024 — Analysis of oncology drug spending growth and the increasing cost burden on employer-sponsored plans.
- Health Affairs: Centers of Excellence for Cancer Care — Employer Outcomes — Research on quality and cost outcomes when employers direct cancer patients to high-volume, specialized treatment centers.
- PBGH: Cancer Care Navigation and Employer Plan Design — Employer-facing guidance on proactive cancer care management, navigation vendor selection, and plan design considerations.
- KFF Employer Health Benefits Survey 2024 — High-Cost Claimants — Data on catastrophic claims concentration — a small percentage of members driving a disproportionate share of plan costs.
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About the Author
Corry Hull, REBC®, CSFS®
VP of Employee Benefits · BHC Insurance
Corry Hull, REBC® CSFS®, is VP of Employee Benefits at BHC Insurance and the founder of Employer Benefits IQ (www.employerbenefitsiq.com). He is a Certified Health Rosetta Advisor — one of fewer than 200 nationwide — and a multi-year presenter at United Benefit Advisors (UBA) national conferences. He specializes in self-funded health plan design, PBM contract strategy, stop-loss structuring, group medical captives, and ACA/ERISA compliance for mid-market employers. His work has been recognized by Health Rosetta (Rosie Award, 2026), UBA (Producer Peak Performer, 2025–2024), and BHC Insurance (Producer of the Year, 2021–2025). His employer-education content has been referenced in BenefitsPro and cited within the Health Rosetta advisor community. All consulting and brokerage compensation is fully disclosed.