With approximately 6.1 million adults treated annually, skin cancer is the most common form of cancer in the United States.[1] It’s also a significant driver of specialty spend for Medicare plans.
During the month of May, which is Skin Cancer Awareness Month, we hear a lot about prevention and early detection. For health plans, however, skin cancer awareness is more about having the tools in place to help identify disease early, connect members with the right treatment, and monitor for recurrence over the long term.
When health plans lack these tools, timely treatment can fall through the cracks. Addressing skin cancer requires a proactive approach—one that identifies at-risk members early and ensures they stay connected to the recommended care.
Post-diagnosis gaps create long-term risk
Melanoma accounts for more than 5 percent of all new cancer diagnoses[2] and carries a high risk of recurrence and progression without timely follow‑up.[3] Therefore, ongoing surveillance of members diagnosed with melanoma is a critical component of long‑term management.
The need for consistent follow‑up is even more pronounced for certain populations. For example, members treated for conditions such as psoriasis and eczema face elevated cancer risk and should undergo more frequent screenings.
National guidelines clearly reinforce the importance of surveillance after diagnosis, but gaps in follow‑up remain common. When members aren’t adequately monitored, health plans face a dual challenge: increased clinical risk for members and rising downstream costs associated with late detection, more intensive treatment, and avoidable disease progression.
Consistent, data-driven follow-up closes gaps
Closing gaps in post-diagnosis care requires a proactive, data-driven approach that consistently identifies at-risk members and ensures they remain connected to care.
Effective programs start with identifying members who have received a melanoma diagnosis but do not appear to have had subsequent follow-up. In addition, after members complete treatment, they must be continually monitored for timely follow-up visits to ensure any disease recurrence is identified quickly.
This level of visibility requires sophisticated algorithms to surface potential gaps early. By leveraging administrative claims data, health plans can identify missed follow-up opportunities and promote early detection of recurrence or new primary melanoma and quickly enable member‑focused intervention.
When at‑risk members are identified, care coordination becomes the critical next step. Communication with dermatologists helps re-establish continuity of care and supports appropriate treatment planning. At the same time, health plans should engage members directly, reinforcing the importance of follow‑up and helping members navigate the next steps in care.
Proactive follow-up improves outcomes while controlling costs
The impact of a follow-up program extends beyond closing individual care gaps. By identifying lapses earlier and facilitating timely follow‑up, health plans can better protect member health while reducing avoidable downstream costs associated with delayed detection. Earlier intervention often means less intensive treatment, lower acuity episodes of care, and more predictable specialty spend over time.
Is your health plan proactively monitoring your members’ health to reduce risk before it becomes significantly more costly to manage? If not, you can learn more about how innovative melanoma follow-up programs can help your health plan better manage skin cancer care and costs in our webinar, Innovations in Specialty Care: Advancing Quality, Outcomes, & Savings in Dermatology, conducted in partnership with RISE. Or request a custom analysis of your plan’s melanoma management strategy at https://myhn1.info/analysis to discover how we can help.
About the author
Dr. H. Kelley Riley, M.D., MBA, chief medical officer at Health Network One, has more than two decades of medical leadership experience. Dr. Riley is responsible for developing and executing the organization’s clinical strategy, ensuring high-quality and cost-effective healthcare delivery.
Before joining Health Network One, he was chief medical officer at SummaCare, where he played a key role in implementing health and wellness initiatives. He’s also held CMO positions at Rite Aid and its subsidiary, Elixir, where he focused on clinical strategy and operational improvements. His career also includes leadership roles at myNEXUS and BlueCross BlueShield of Tennessee, providing him with extensive expertise in managed care and specialty health services.
Dr. Riley earned his M.D. from Michigan State University, an MBA from Western Michigan University, and an MS in finance from Johns Hopkins University. He also is a certified professional coder (CPC) and certified professional compliance officer (CPCO), highlighting his expertise in medical coding and health care compliance.
[1] Melanoma of the Skin Statistics | Skin Cancer | CDC. April 17, 2026.
[2] Melanoma of the Skin — Cancer Stat Facts. National Cancer Institute. 2026.