Oncology Learning Collaborative

Oncology Learning Collaborative


In the Fall of 2023, MBGH and the Florida Alliance for Healthcare Value collaborated with employer members to share insights, information and resources in their management of oncology benefits and to ensure these benefits accomplished the 5 patient rights – right care, right person, right place, right time and right price. Key topics included:

  1. Prevention, Screening/Testing, Early Identification & Site of Care
  2. Navigation, Psychosocial Support, Survivorship & Return to Work
  3. Diagnosis, 2nd Opinion, Precision Medicine/ Biomarkers & Treatment


Perspectives were gathered from employer members of each coalition during three work group meetings and three webinars. The final webinar offered employer panels on the various topics and project activities will result in the Employer Insights and Guide to Oncology Management which will launch in the first quarter of 2024 and provide:

  • Employer action steps on oncology management to protect an employer’s fiduciary duty
  • Recommendations on the key topics to ensure benefit designs for medical and pharmacy benefits don’t crate barriers for effective cancer care
  • Learnings on what is working and not working in oncology management benefits and services
  • Access to vetted and cited resources, tools and articles
  • Questions to ask to medical carriers and PBMs to ensure benefits provide the right value and outcomes

Business Case

Cancer has become more complex and challenging with:

  • Rapidly expanding diagnostic testing and treatments with updates to health plan coverage not always keeping pace
  • Wide variations in oncology care across settings and programs
  • Reimbursement challenges with increased billing errors, denied claims needing appeals, prior authorizations delaying care
  • Fragmented, siloed healthcare system with poor communication linkages between stakeholders

In 2022, Business Group on Health’s Healthcare Strategy and Plan Design Survey found cancer had become the top driver of employer healthcare costs:

  • Increasing utilization and unit cost of specialty pharmacy drugs
  • More cases of cancer at a later stage
  • More awareness about variation in patient outcomes and quality of care
  • More understanding of the value of adherence to evidence-based care
  • More feedback on the challenging patient experience – clinically and financially

Business Case for Employers

  • 1 in 3 cancer patients enter bankruptcy
  • High percentage of patients are initially misdiagnosed
  • 74% of patients do not seek 2nd opinions
  • Most money spent in the last two weeks of life
  • Employees do not understand their benefits despite the best efforts of employers to educate them
  • Most cancer patients would benefit from mental health support but do not receive it during their treatments/cancer journey
  • Employers often cannot address the underlying social and economic conditions in which their employees live, but they can try to understand the social risk factors their employees are exposed to and work to mitigate the social needs being experienced by employees
  • Privacy is important – employees like having “anonymous, non-judgmental” support outside of the work setting when dealing with serious health conditions like cancer