Cancer has surpassed musculoskeletal conditions as the leading factor driving employers' health care costs, according to the 2023 Large Employers' Health Care Strategy and Plan Design Survey from the Business Group on Health.

Eighty-three percent of respondents cited cancer when asked to select the top three conditions driving costs. Musculoskeletal conditions, the leading factor in 2020 and 2021, ranked second at 75%. Rounding out the top 10 were:

• Cardiovascular disease, 30%
• Diabetes, 28%
• High-risk maternity/NICU, 18%
• Mental health, 17%
• COVID-19 (including long COVID), 10%
• Gastroenterology, 7%
• Substance use disorders, 2%
• HIV/AIDS, 1%

Employers already have seen the impact of long-term mental health issues and increased medical services because of delayed care during the pandemic, and many employers anticipate more late-stage cancers as well as higher chronic condition management needs. In response, employers are implementing several strategies to help address cancer costs, including delivery system changes, precision medicine and more preventive screenings.

• Half of employers will have centers of excellence in place for cancer in 2023, and another 26% are considering implementing them by 2025.
• One-third will cover genomic testing for cancer treatments in next year, with another 14% considering doing so by 2025.
• Eleven percent of employers will cover multi-cancer early detection blood tests in 2023.

The survey found that the percentage of large employers who view their health and wellbeing strategy as integral to their workforce strategy has skyrocketed in recent years. Sixty-five percent of employers consider their health and wellbeing strategy to be integral, up from 42% last year and 27% in 2018. One-third said it is only a consideration, and just 3% view it separately from their workforce strategy.