What is utilization management in oncology?
Utilization management (UM) uses tools such as medical necessity review and clinical pathways to help ensure costly therapies are used appropriately and supported by clinical evidence. In cancer care, it confirms that a treatment matches the patient’s tumor type, molecular profile and stage of treatment, and follows guidelines. Reviews are best led by teams that include oncology pharmacists and board-certified oncologists.
Read: The New Cancer Curveball: Why Rising Rates Among Working Adults Could Hit Your Wallet Too
Why does oncology management need clinical experts?
Oncology costs are rising, the drug landscape changes rapidly and partnering with oncology providers is harder than ever. Reviews led by oncology pharmacists and board-certified oncologists help keep pace with new therapies, apply evidence consistently and work more collaboratively with providers.
How does digital care management add to cancer utilization management?
Utilization management and prior authorization focus on the treatment itself. Digital care management goes further, closing gaps in the member experience between visits, which helps address total cost of care for health plans, employers and members.
What is the Quadruple Aim in cancer care?
It means pursuing four goals together: better member outcomes, managed costs, a better experience for members and less friction for providers. OncoHealth’s oncologists and oncology pharmacists help plans build research-informed utilization management strategies while reducing provider abrasion through collaborative decision-making.
How do rising oncology costs affect both health plans and patients?
As oncology costs climb, health plans face pressure to manage financial risk while protecting access to quality care. Patients face a parallel strain: financial stress can affect their treatment decisions, adherence and outcomes. Social work and care navigation can help reduce that burden.
Read: Webinar: We’ve Got You Covered: Financial Risk, Patient Impact, and the Path Forward
Is cancer a top healthcare cost for employers?
Yes. Cancer ranks as the top healthcare spend for U.S. employers, and costs keep rising. 70% of employees with cancer miss four weeks or more of work, presenteeism costs an estimated $4,000 a year per employee with cancer, and 56% of emergency room visits by employees with cancer are avoidable with the right support.
What can employers do about rising cancer costs?
Invest upstream: workplace wellness programs, promoting cancer screenings and benefit designs that reward preventive care and early detection. Alongside that, responsible utilization management helps balance access to the right treatment with affordability.
Read: The New Cancer Curveball: Why Rising Rates Among Working Adults Could Hit Your Wallet Too
Why are cancer costs rising for employers?
Employers are bracing for the largest health premium increases in 15 years, close to 9.5% in 2026. One driver is the rise in cancers among working-age adults: colorectal, uterine, kidney and pancreatic cancers are appearing more often in people under 50. Modern treatments such as immunotherapies, targeted biologics and genomic testing are also major cost drivers.
Read: The New Cancer Curveball: Why Rising Rates Among Working Adults Could Hit Your Wallet Too
How much do patients pay out of pocket after a cancer diagnosis?
Among privately insured patients, especially those in high-deductible plans, out-of-pocket costs in the first six months of treatment typically exceed $3,500 to $4,700. Lost wages and time away from work add to the burden.
Read: The New Cancer Curveball: Why Rising Rates Among Working Adults Could Hit Your Wallet Too