Care for the most common cancers tops $156 billion a year among privately insured patients under 65. Most cost-containment tools were built for conditions where member behavior drives outcomes and spend. Cancer flips that: The oncologist’s treatment decision, often made once, drives both.
Getting that decision right is challenging. Cancer science moves faster than any single physician can track, and most cancer care happens in community settings, where subspecialty expertise rarely reaches treating oncologists.
This whitepaper details a model that finds eligible cases automatically and connects community oncologists with subspecialists at National Cancer Institute-designated comprehensive cancer centers. Those subspecialists found room to change the treatment plan in 85% of cases, including misdiagnoses and plans that needed revision. Treating oncologists adopted more than half of recommended changes.
Learnings include:
- Why typical second-opinion programs for cancer reach just 3% to 7% of eligible members
- How claims data verifies adoption
- The modeling behind an estimated $32,000 in average savings per adopted recommendation