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Oncology Care Management Programs for Health Plans

Manage cancer costs and improve outcomes and quality of care.

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Oncology solutions to address complex challenges

Our cancer specialists align the right care at the right time with the right provider, grounding all we do in evidence-based medicine. Here’s why we can help:

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Cancer costs on the rise

The cost of cancer care continues to rise and is expected to reach more than $240 billion by 2030.1

Increasing number and complexity of treatments

The FDA has approved 43 new cancer drugs and 114 new indications for current cancer drugs.2

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More cancer diagnoses

38.4% of Americans will be diagnosed in their lifetime.3

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Growing evidence base

Medical knowledge doubles every 73 days.4

Infographic showing Optum process through the cancer journey Infographic showing Optum process through the cancer journey

Cancer Support Program

The Optum® Cancer Support Program (CSP) is an integrated approach that closes gaps in care. With CSP, members have access to a specialized nurse case manager and support from an entire team of cancer experts.

CSP nurse case managers provide network guidance, education, pain management, treatment adherence, and palliative and end-of-life care.

Ensuring the patient’s condition is properly managed helps avoid hospitalizations, emergency department visits and inappropriate treatment, thus reducing the total cost of care for clients.

  • Participant Net Promoter Score® of 685
  • Cancer Support Program is used to support of 17 million+ members across multiple clients6
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Cancer Guidance Program

The Cancer Guidance Program (CGP) is a utilization management service for oncology treatments that leverages technology and appropriate clinical intervention from oncology clinicians to ensure members are receiving high-quality medical care at lower costs. It reviews use of both medical oncology and radiation oncology treatments.
View Available Oncology Pathways

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CGP supports 29 million members across multiple clients. The program has 7 case studies demonstrating a 4:1+ ROI.7

The results

  • 85% of requests entered by provider through CGP website (time frame: 2022–2023)8
  • 96% preferred product adherence (time frame: 2022–2023)8
  • 20% adherence in pathway adoption (time frame: 2022–2023)8

The Specialty Guidance Program (SGP) and CGP are closely connected. CGP focuses on cancer conditions, while SGP focuses on specialty non-cancer conditions.

Cancer Resource Services

Cancer Resource Services (CRS) provides access to top-performing cancer centers across the country, known as our Cancer Centers of Excellence (COE) network. It is particularly useful for individuals looking for a second opinion on their cancer diagnosis or treatment.

The Optum COE network includes 39 leading cancer centers that meet strict evaluation criteria such as:

  • A multidisciplinary approach to care
  • Program depth and breadth
  • Best-practices medicine
  • Patient- and family-oriented programs and services
  • Patient volumes
  • Treatment planning and coordination
  • High-quality clinical research
  • Patient safety

The results

  • 50,000+ members supported since 20019
  • Plans save on average $14,000 each time they use an Optum COE9
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Value-based care and oncology practice consulting

Optum Health experts will work with providers to implement incentives for quality initiatives and and evidence-based clinical pathway adherence. By supporting providers in practice transformation and performance reporting analytics, the quality of care will improve and the value of cancer care will improve.

Learn more about our solutions

Fact sheet

Oncology solutions

Learn more about all Optum Oncology Solutions and the many benefits that could help you.

White paper

Oncology trends

Stay on top of the latest insights in cancer treatment.

White paper

Specialty Guidance Program

Learn about what's new in the Specialty Guidance Program and all the benefits it provides.

Sources

  1. National Center for Chronic Disease Prevention and Health Promotion. Health and economic costs of chronic diseases. March 2023. Accessed April 2023.
  2. Optum Health Solutions analysis from updates posted on FDA website, 2022.
  3. National Cancer Institute. Cancer statistics. Last updated April 27, 2018. Accessed January 2023.
  4. 2023 Optum book of business analysis.
  5. NPS: OHS Oncology team, 2022.
  6. OHS Oncology team, as of Dec. 2022. 7 Case Studies: based on OHS Oncology and/or Client Analytics analysis and validated by clients, as of Dec. 2022.
  7. Ibid.
  8. 2023 OHS Oncology Analytics as provided through PowerBI / Tableau.
  9. OHS Oncology analysis based on client book of business, 2022.