“Time Is Money”: Why Eliminating Cancer Treatment Delays Is a Business Imperative for Health Insurers & Cancer Providers
Imagine a woman in her early 50s—let’s call her Maria. She finds a lump in her breast and quickly gets a mammogram. It confirms her worst fear: breast cancer. Fortunately, the tumor is small and localized. Her doctors say it’s highly treatable. But the next steps are anything but swift.
Maria’s care stalls while she waits days for authorization to see a surgeon, and then three weeks more for the initial appointment with a surgeon. Then, a backlog in imaging pushes her MRI out by two more weeks. Next, prior authorization for surgery takes several more days before surgery is finally scheduled weeks later. Before she knows it, 65 days have passed. When treatment finally begins, her cancer has progressed. What could have been a straightforward lumpectomy now requires more extensive breast surgery, potentially more extensive lymph node surgery, and/or more aggressive drug therapy.
Sadly, Maria is not alone.
The Hidden Epidemic of Delays
Across the U.S., 1 in 5 insured cancer patients experiences a delay of more than 60 days between diagnosis and the start of treatment. Among Black, Hispanic, and Medicaid-enrolled patients, this number climbs to nearly 30%, according to national claims data.
These delays aren’t just inconvenient—they’re deadly. For patients like Maria, each week of delay can reduce survival by 1.2–3% in relative terms, depending on the type of cancer. For breast cancer, a delay of more than 60 days is associated with:
- An 8–10% relative decrease in 5-year survival,
- A 30–60% relative increased likelihood of requiring chemotherapy,
- Higher hospitalization rates, and
- 40% higher total costs in the first year after diagnosis.
When Cancer Waits, Costs Skyrocket
From the insurer’s perspective, treatment delays carry a steep price tag. For early-stage breast cancer patients treated promptly, the cost of care may include:
- Lumpectomy (~$15,000)
- Radiation therapy (~$10,000–$20,000)
But once breast cancer progresses due to delay, that same patient might require:
- Mastectomy (~$25,000)
- Chemotherapy (~$40,000–$80,000)
- Reconstructive surgery and extended inpatient care (~$50,000+)
According to SEER-Medicare data, the average monthly cost for late-stage breast cancer is 4.5x times higher than for early-stage cases. And this doesn’t even account for the administrative burden: prior authorizations, peer-2-peers, scheduling, care coordination, etc.
Greater Patient Financial Toxicity
Treatment delays increase healthcare costs not only for insurers but also for patients. According to the Kaiser Family Foundation, once patients meet their deductible, they are typically responsible for 20% of specialty care costs. Thus, a 4.5X increase in healthcare cost can dramatically increase the financial burden for cancer patients.
Quality Standards Are Tightening
Recognizing the cost and clinical burden, leading institutions like the Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers (NAPBC) now require that treatment begin within 60 days of diagnosis. Cancer providers are expected to align with this standard or risk loss of accreditation.
But meeting these benchmarks isn’t just about compliance—it’s about saving the lives of cancer patients.
Why Delays Happen—and What Health Insurers and Cancer Providers Can Do
So what’s causing these delays? Often, it’s not the patient—it’s the system:
- Prior authorization delays
- Inadequate care navigation
- Specialist shortages
- Fragmented workflows
- Barriers related to transportation, language, or financial hardship
These are solvable problems. Solutions include:
- Accelerating prior auths for guideline-concordant treatments
- Deploying digital navigation platforms to coordinate scheduling and reduce no-shows
- Flagging at-risk patients using claims and SDoH data
- Partnering with high-capacity oncology centers to reduce wait times
In short, the ability to reduce delays is already within reach—what’s needed is technology that helps to streamline these processes..
The Opportunity to Drive Better Outcomes while Improving Financial Sustainability
Reducing treatment delays is more than a quality-of-care issue—it’s a financial strategy. Timely treatment:
- Lowers total medical spend
- Prevents high-cost acute interventions
- Reduces administrative burden
- Improves outcomes and patient/member retention
- Enhances compliance with HEDIS® and STAR measures
In an industry facing rising costs and narrowing margins, eliminating treatment delays is one of the clearest paths to clinical and financial ROI.
Take Home Message: Timely Care Delivers Better Outcomes and Greater Value
For health insurers and cancer providers, every delay carries risk. For patients like Maria, it can mean the difference between recovery and recurrence, low- vs. high-intensity treatment, manageable vs. catastrophic costs—and ultimately, the difference between life and death.
By investing in solutions that enable timely care, health insurers and cancer providers save lives, control costs, and uphold their commitment to delivering high-quality, equitable care to every patient.
.svg)
.svg)