Cancer costs top healthcare spending four years running and continue to rise. Plan design will not save you.

To change the trajectory of cancer, we have to change the way care is delivered.

Employer healthcare costs are projected to climb nearly 10% in 2026, according to a new Business Group on Health survey. And we’re hearing from many of our customers directly that they are expecting mid- to high-double-digit increases.

For the fourth year in a row, cancer is the top condition increasing employer health spend. Late-stage diagnoses and rising prevalence among working-age adults mean costs keep accelerating. Even the most creative plan structures won’t change this trajectory. The real opportunity is to change how care is delivered. 

What’s different about cancer?

Cancer is not one disease, nor does it follow a simple path. By the time a late-stage diagnosis has happened, the opportunity for cost savings is minimal. No benefits leader wants to be put in a position of limiting life-saving care, either. 

Today, the avenues for screening and earlier detection are essentially dependent on stretched, overwhelmed primary care networks. It’s no wonder that 30-50% of cancer cases are diagnosed following an ER visit for an acute symptom. 

And with the dramatic increases in cancer incidence among working-age individuals, there is a big gap in traditional care today—how to risk-assess, educate, and screen younger individuals who are at increased risk of cancer.

How do you bend the cost curve on cancer?

Fundamentally, the only impact on cancer costs that will make structural change long-term is earlier detection and diagnosis, at scale. That means:

• Everyone does their recommended screenings, on-time, and cost-effectively
• High-risk individuals—most likely to be high-cost claimants–get the right screening and risk reduction plans early
• Any abnormal screening result gets to a diagnosis as quickly as possible (weeks vs. months or years)

This is a population health and access challenge, not a coverage one.

Plan design alone won’t solve these problems.

We meet many employers who are trying to take important plan design steps, specifically around coverage for cancer screenings or diagnostic follow-ups. For example, they are deciding to cover screening mammograms 100% for anyone at any age, or covering diagnostic colonoscopies at 100% for anyone with an abnormal colon cancer screening. 

Each of these efforts is the right intention, but is not going to change outcomes at the scale needed to reduce the eye-popping cost increases in cancer. 

Why?

1. Addressing the full breadth of cancer screening and diagnostic access is effectively impossible through plan design. We have customers who have struggled to get coverage expanded for even one cancer screening or diagnostic test through their health plan.
   
   An employer we spoke with tried to cover diagnostic breast MRIs at 100% to improve the likelihood of people doing their screening mammograms. Their health plan told them that it was not possible to carve out just diagnostic breast MRIs, and the coverage would need to extend to most other MRI orders as well. We’ve seen that it’s just incredibly difficult to provide full coverage of more than one or two high-cost cancer conditions or full coverage of all diagnostic follow-ups even in just one cancer condition.
2. Coverage ≠ use. Employees, and their PCPs, likely do not know the extent of their own coverage. For example, it may be assumed a diagnostic prostate MRI will carry a significant out-of-pocket cost, when in fact the plan design covers most of it. And having better coverage does not mean that employees will be risk-assessed appropriately by their PCPs, or that they will be able to get into specialty services, like a dermatologist for a skin check, sooner than one year out. 

Access to care, speed of follow-ups, cancer expertise, and broad education efforts all are necessary alongside coverage to improve outcomes at the scale needed to actually change costs.

What employers need to look at differently.

Employers need to rethink the care model. Cancer—like the other major high-cost categories (mental health, cardiovascular, MSK, and women’s health)—has shown it demands a rebuilt approach. 

It’s an opportunity to move your investment to what matters, driving direct utilization of screenings, faster access to imaging and diagnosis, coordinated treatment, and complex clinical care for cancer survivors. 

At Color, our customers are saving money immediately by shifting their spend to direct access to care at lower prices than their traditional networks. This is demonstrating >2:1 ROI in year one on direct savings alone, and it’s driving up to 77% increases in screening rates, plus engaging employees in cancer care who have not had a medical claim in over 12 months.

Employers who invest in proactive, direct, oncologist-led cancer care will not only lower costs, but also build healthier, more resilient workforces. Those who wait will face compounding costs and greater workforce impact.

Want to see how proactive cancer care can change outcomes and costs for your workforce? Email us at learnmore@color.com