Employers Weigh More Than Cost in Cancer Care: Karen van Caulil, PhD

Although cancer has long been the leading cost driver for employer-sponsored health plans, employers are weighing far more than spending when they evaluate cancer care, according to Karen van Caulil, PhD, president and CEO of the Florida Alliance for Healthcare Value.

At the Community Oncology Alliance Payer Exchange & Innovation Summit on September 15, van Caulil was a panelist during the session “The Employer Perspective: Investing in Innovative Cancer Care Solutions,” during which she and other experts discussed the factors that should guide employer investment in new cancer care solutions, as well as the equity considerations that shape which investments reach all patients.

In part 1 of an on-site interview, she told The American Journal of Managed Care^® that when she joined the Florida Alliance for Healthcare Value 15 years ago, back when it was called the Florida Healthcare Coalition, her first meeting focused on identifying newly diagnosed members and steering them quickly to available services, conversations that are still happening today. What has changed is the amount of innovation available to ensure patients receive the right diagnosis and care matched to their genetic makeup, van Caulil noted.

The stakes are rising as more plan members are diagnosed at later stages and at younger ages, meaning a larger share of the workforce is affected. Still, van Caulil stressed that employers “care very deeply about their workers,” prioritizing high-quality, timely care that improves outcomes and helps employees return to work and their lives, sometimes even during treatment.

Waiting weeks for a first consult after a diagnosis is “unimaginable,” van Caulil said, adding that administrative processes tied to testing and therapies must be streamlined. Quality also matters; employers do not want members seeing providers without expertise in their specific cancer type.

Reflecting on a remark made earlier in the summit that innovation is not truly innovation unless all patients can access it, van Caulil acknowledged that the Florida Alliance often fields calls from people seeking help to expedite oncology appointments. Although the organization can usually help, she said access “can't be one-off,” as everyone should have timely access, not just those who know to ask for help.

Therefore, van Caulil urged employers to analyze their data by age, race, ethnicity, and occupation to confirm all members receive timely screenings and primary care visits. She also advised them to investigate any gaps, whether driven by community, culture, or language.

“There’s a lot to take in when you're looking at access and also equity,” van Caulil concluded.