From administrative burden to clinical opportunity

Cancer isn’t just another high-cost condition; it’s the single biggest opportunity for health plans to improve patient outcomes and bend the cost curve.

Too often, health plans view cancer as a cost challenge to manage rather than a set of clinical opportunities to lead. Yet cancer still remains the top driver of healthcare spend across employers and payers. The American Cancer Society estimates national cancer-related medical costs now exceed $200 billion, while the Business Group on Health reports that cancer has driven employer cost increases for four consecutive years.

Cancer is now one of the most advanced yet fragmented areas of modern medicine. Breakthrough therapies and improved survival coexist with widening access gaps, earlier onset of disease, and unsustainable costs. 

Despite this complexity, many health plan oncology strategies engage with members too little and too late, when both outcomes and costs are hardest to change. To truly shift results, we need a new model: one built on proactive, clinically-integrated, expert cancer intervention across the care continuum.

The limits of traditional case management

Health plans often lean on case management programs as part of the core oncology strategy. Traditionally, these services add value by helping members navigate complex systems, coordinate appointments and support symptom management. But engagement typically begins too late to influence what matters most: early detection, timely intervention, and outcome trajectory.

By the time a cancer diagnosis appears in claims data, the opportunity to prevent advanced disease—and avoid its costs—and optimize initiation of guideline-concordant care is gone. Stage III and IV cancers account for most oncology spend, yet case management programs are constrained from touching prevention or early diagnosis. These programs are designed to react to individuals with certain claims codes, not shape the health of the population. What’s missing is a single, accountable partner who can influence cancer outcomes across the entire continuum of care.

The case for a proactive, integrated oncology strategy

Imagine if fewer patients needed chemotherapy because cancers were caught earlier and treated more effectively. Imagine if all patients with cancer lived longer, high quality lives because they received expert-informed, guideline-concordant cancer treatment and survivorship care. All of these goals require proactive, timely expert engagement.

Color Health’s Virtual Cancer Clinic, a 50-state, oncologist-led medical group, moves oncology strategy upstream, where change is most powerful.

Unlike limited navigation services or bolt-on models, Color builds a direct, continuity of care physician–patient relationship to deliver multidisciplinary, evidence-based cancer care from early detection through survivorship. By partnering with health plans, this integrated model enables earlier action, smarter clinical interventions, and measurable improvements in both outcomes and cost.

Cancer is a continuum, not a single event

Cancer develops long before diagnosis, shaped by lifestyle, genetics, and environment. Cancer outcomes are influenced long before treatment begins, determined by stage, work-up, and treatment choices. The most effective oncology strategies intervene early and often, addressing risk across cancer prevention, detection, treatment, and survivorship. Key opportunities include:

• Personalized prevention and screening intervention based on clinical risk
• Closed screening gaps before symptoms appear
• Shortened the time from abnormal findings to confirmed diagnosis
• Faster paths to starting the right treatment approach at the right place, the first time
• Expert guidance for evidence-based treatment
• Proactive oncologist-led evaluation and management of symptoms, including prescriptions and orders that avoid ED visits
• Expert survivorship care, including close monitoring and management of long-term complications and cancer recurrence

These are the moments that define both patient outcomes and spend, and many occur well before traditional case management begins and well-after treatment support services end.

From coordination to clinical integration

Many oncology programs offer to coordinate care; few deliver clinical integration. Coordination connects patients to services. Integration connects decisions, delivering direct clinical interventions, in coordination with treatment teams, that change outcomes and reduce avoidable utilization.

To transform results, health plans need a single, accountable clinical partner that unites expert care delivery, data, and case management to intervene early enough, effectively enough and frequently enough to change disease (and cost) trajectories. Oncologist-led, multidisciplinary teams ensure decisions align with guidelines and the member’s full clinical picture. This model expands services from solely helping members manage cancer-related tasks to actively ensuring high quality cancer care.

Redefining case management’s role

Case management remains vital. When embedded in a clinically integrated framework, its impact expands. Working alongside oncologist-led multidisciplinary teams, case managers become the connective tissue between members and specialized clinical care. This approach pairs human guidance with clinical action, changing the trajectory of care and avoidable cost through earlier, more effective intervention. 

The result: a better member experience, more effective, guideline-concordant care and lower avoidable utilization, all translating to measurable value. 

A new standard for oncology strategy

Health plans face a choice. They can continue managing cancer as an administrative challenge or lead with a proactive, physician-led model that acts earlier to reduce both clinical and financial risk.

The first approach maintains valuable but reactive programs that start too late to shape outcomes. The second builds on those foundations with clinical integration, enabling earlier engagement, faster intervention, and sustainable results.

At Color Health, our Virtual Cancer Clinic extends traditional case management with direct physician engagement and oncologist-led care, creating a single, accountable framework that supports members from risk identification through survivorship.

Cancer is no longer a single event to manage. It’s a continuum of care to lead. Health plans that act now will define the next generation of oncology strategy.