Cancer is the largest unmanaged cost risk facing employers, yet new research from Lantern and AccessHope reveals a troubling disconnect. While employers recognize the importance of expert cancer care, few have built a benefits strategy around it that actually improves outcomes and lowers costs.
In our recent webinar, Associate Chief Medical Officer Dr. Stephen Speicher from Lantern joined VP of Consultant Relations Alex Burggren from AccessHope to unpack findings from The Cancer Attention Gap report.
In this webinar, you’ll learn:
- Why cancer needs to be top of mind when shaping benefits plans
- What really drives cancer-related costs
- How integrating subspecialty expertise with personalized support delivers better outcomes and greater control of spend
Many Employers Aren’t Executing the Right Cancer Care Strategy
While 94% of employers believe that early expert review improves cancer care outcomes and reduces costs, only 6% surveyed have oncology experts formally embedded into their review process. Burggren says that disconnect was the largest gap uncovered in the research.
Cancer has also become increasingly specialized, making it more difficult to understand if employees are getting the right treatment.
“The sub-specialization in oncology has become almost sub-sub-specialization,” said Dr. Speicher, a practicing pediatric hematologist and oncologist. “It’s impossible for any general oncologist to know everything across every disease and treatment. I can’t think of another field of medicine that has had this level of transformation.”
He added that we really need expert review earlier in the care journey, before treatment decisions lock employees with cancer into a path that may be difficult and costly, or even lead to unnecessary care.
Many employers also still rely on carriers, PBMs and consultants or have no formal review process when evaluating high-cost cancer decisions. They may have full visibility into cancer spend, but they may not know how to improve outcomes and reduce spend.
“They may say, ‘I don’t even know how to start chipping away at this, so I’m going to throw my hands up and hope for the best’,” Dr. Speicher said.
Specialized Review Can Improve Cancer Outcomes, Lower Costs
When employers incorporate specialist review into the cancer care journey, employees gain access to disease-specific expertise that validates diagnoses, identifies additional treatment opportunities, and helps ensure care decisions reflect the latest evidence and clinical research. As cancer treatment becomes increasingly complex, that level of precision can significantly impact both outcomes and costs.
One of the strongest examples Burggren and Dr. Speicher discussed during the webinar involved a lung patient whose tumor carried an EGFR mutation.
Without specialized review and biomarker testing, the patient followed a more traditional treatment pathway, driving total 12-month costs to $339K while producing a projected two-year survival rate of 30 percent.
When sub-specialist review identified the mutation and guided the patient toward targeted therapy, those projected costs dropped to $238K, while two-year survival increased to 86%. “The more clinically precise treatment was the less expensive one,” says Burggren.
Reducing cancer costs isn’t necessarily about restricting care. Instead, it’s about ensuring employees receive the right care from the beginning of a cancer diagnosis.
Report: The Cancer Attention Gap
Is your cancer care benefits strategy meeting your goals?
Lantern & AccessHope surveyed benefits leaders to learn whether their strategies are lowering costs and improving outcomes.
Humans Matter When It Comes to Cancer Support for Employees
Even the best clinical recommendations only create value if employees understand their options and feel supported enough to act on them. Throughout the webinar, Burggren and Dr. Speicher emphasized that ongoing nurse navigation plays a critical role in helping members navigate cancer treatment decisions, access care and manage challenges.
Dr. Speicher shared the story of Paul, a Lantern member diagnosed with a rare blood cancer called polycythemia vera. Despite feeling healthy, routine blood work uncovered the disease, launching him into what he described as an overwhelming experience.
Through Lantern, Paul was paired with an oncology nurse navigator who helped him understand his treatment options, secure medication coverage and navigate the complexities of his diagnosis.
The result was not only a more targeted treatment approach, but approximately $16K per month in medication savings for Paul. “Lantern was invaluable. It gave me purpose and peace of mind during the hardest time of my life. It reminded me I wasn’t in this alone,” Paul told his employer.
Dr. Speicher said that support is the true secret sauce of a successful cancer care benefits strategy. “We’re trying to build peace of mind for members during what will likely be one of the hardest things they ever go through,” he said.
What Employers Can Do to Ensure a Successful Cancer Care Benefits Strategy
While many organizations still lack the infrastructure to meaningfully influence cancer outcomes and costs, Burggren and Dr. Speicher outlined several practical steps employers can take to close that gap.
1. Prioritize expert review where it matters most
Dr. Speicher said the most important decision in a cancer care journey often happen within the first days and weeks after a diagnosis. Assess whether members have access to cancer-specific expertise when critical treatment decisions are being made.
2. Support members throughout the entire cancer care journey
Cancer care is often a long, evolving journey, requiring support beyond diagnosis. Relapse, recurrence, treatment toxicity, unexpected complications and changes in clinical condition all create opportunities to offer support to help members understand their options, manage side effects, coordinate care and gain access to additional expertise.
3. Don’t confuse visibility with control
Benefits leaders may have access to cancer spend data, but far fewer have the tools to influence what happens after they identify a problem. “Monitoring isn’t managing,” Burggren said. Put mechanisms in place to influence treatment decisions, guide members to evidence-based care, and prevent avoidable complications.
4. Validate that your cancer care strategy is changing outcomes
Employers often measure cancer strategies through visibility, utilization or reporting, but it really requires a deeper look.
Ask questions like:
- How often are treatment plans reviewed by oncology experts?
- How frequently are recommendations adopted?
- Are members receiving guideline-concordant care?
- Are avoidable ER visits, toxicities, or hospitalizations being reduced?
- Are members reporting better support and confidence during treatment?
5. Build an integrated cancer care strategy, not a collection of point solutions
No single intervention solves the challenges benefits leaders face when it comes to cancer care for employees. Expert review, nurse navigation, treatment validation, symptom management and ongoing support all work together.
When point solutions operate independently, gaps emerge. When services are integrated, employers have greater opportunities to influence outcomes, improve the member experience and create more predictable spend.
Learn how Lantern can Support your Cancer Care Benefits Strategy
