Managing a Cancer Diagnosis as a Self-funded Health Plan

Self-funded employers bear the financial responsibility of providing healthcare to their employees. This model offers greater control over benefits and potential cost savings. However, the unpredictability and high costs associated with cancer treatments can pose substantial financial risks. Effective cost management and positive health outcomes are key considerations, making it essential to consider how your self-funded plan will manage cancer cases.

To benefit both the employee battling illness and the self-funded employer, oncology management programs need to take a comprehensive approach to care.

The Impact of Cancer on Self-Funded Plans

In 2024, approximately 2 million people were diagnosed with cancer. The latest research from the National Cancer Institute (NCI) estimates the cost of cancer care will reach $240 billion by 2030. Behind heart disease, cancer is the second leading cause of death for adults in the United States. Unsurprisingly, this makes cancer one of the most expensive diagnoses for health plans. Employers with self-funded health plans see the financial impact of a cancer diagnosis in the cost of treatment, as well as the impact on their employees’ ability to work, their quality of life, and overall well-being.

Depending on the type of cancer, treatments, insurance, and other factors, the exact cost of cancer care will vary. Overall, the financial burden can be staggering. The NCI estimates the per-patient costs average $43,516 for initial care (treatment that takes place within the first year of diagnosis).

The financial strain on self-funded plans is exacerbated by the escalating costs of innovative cancer treatments. Advancements such as immunotherapy and targeted therapies have improved patient outcomes but come with high price tags. In 2023, global spending on cancer medicines reached $223 billion, with projections indicating it could grow to $409 billion by 2028.

The Employer’s Role 

Self-funded employers must balance cost control with providing comprehensive, high-quality care for their employees. Without a structured oncology management program, plan costs can escalate due to expensive treatments, emergency room visits, and inpatient stays.

Taking a Personalized Approach to Cancer Care 

In order to best support employees while keeping an eye on their bottom line, self-funded employers need to find a TPA partner who takes a whole-person approach.

Healthgram’s Oncology Management program functions as both an employee and plan advocate, offering the following benefits:

• Personalized support. After diagnosis, the patient is assigned a designated and specialized case manager from Healthgram’s clinical department. The case manager will work closely with the patient, the patient’s family, and physicians throughout treatment.
• Complete integration. As a service provided by Healthgram’s clinical department, no outside vendor is necessary. Patients have a single point of contact within the Healthgram ecosystem.
• Early engagement. Case management nurses have complete access to claims and patient notes to seamlessly coordinate care, even in the most complex cases. Our proactive approach to oncology engages patients early on and achieves deep savings.
• Cost control. Proactive support that finds alternative treatment settings and reduces ER and inpatient visits.
• Stop loss coordination. Timely and thorough clinical notes and claim details.

The goal of the Oncology Management program is to help sick employees receive the best care possible while implementing cost control strategies. For example, one member required chemotherapy and a stem cell transplant. The member’s designated case manager stepped in, and after thorough research, discovered that the member qualified for federal assistance through a special program. By redirecting all claims to this program, the plan saved over $215,000 in treatment costs — helping both the member and the plan navigate this challenge more easily.

A strategic oncology management program can help ensure better outcomes and financial sustainability for all.

To learn more, reach out to a member of our team.