Epidemiology Exposes a Broken Incentive: Breast Cancer Reimbursement Rewards Burden, Not Prevention
Introduction
When it comes to breast cancer, the evidence is overwhelming: early detection saves lives. National guidelines recommend mammograms every two years for women starting at age 40, and studies consistently show that screening improves survivability. Yet when we analyzed reimbursement data across states and payers, we found a troubling reality: reimbursement has no connection to prevention. Instead, payment increases only when outcomes worsen.
Prevention Doesn’t Pay
Our analysis confirmed that screening rates for women over the age of 40 by state were not significantly associated with reimbursement levels. States with higher uptake of mammography saw no improvement in reimbursement for providers delivering those services. The same was true for new diagnoses: the incidence of breast cancer is not significantly tied to payer reimbursement. Early detection is the foundation of most breast cancer awareness campaigns, and yet the financial incentives lag behind the marketing campaigns. Though nationally there has been steady movement toward value-based care, this reality contradicts those principles.
Value-based care is built on the idea that providers should be rewarded for keeping patients healthy, reducing avoidable hospitalizations, and improving long-term outcomes. Instead, payment still tracks with the cost of treating disease once it becomes complex, leaving prevention undervalued and misaligned with the very goals of a value-based system. As a result, systems face a structural lack of incentives to prioritize prevention, even though it is widely understood to improve outcomes and reduce long-term costs.
Healthcare Hardships Unlocks Dollars
By contrast, reimbursement increased when outcomes worsened. Mortality was assessed in two ways: as a population-adjusted mortality rate and as the proportion of patients who died relative to incidence. In both cases, states with higher mortality saw higher reimbursement. Payments rose once disease became unavoidable, when complexity and costs escalated. Payers appear more willing to compensate providers once the system is already facing advanced disease and higher acuity, rather than rewarding the work that could have reduced those outcomes in the first place. In effect, dollars are unlocked only when patients get sicker, tying financial incentives to treating late-stage complexity instead of preventing it.
The Incentive Misalignment
This creates a dangerous paradox: prevention, which saves lives and reduces long-term costs, is undervalued, while late-stage disease management is rewarded. For patients, this often means that health systems lack the financial support to expand preventive programs, leaving early detection inconsistent and uneven. For providers, it makes investing in screening and early detection financially harder to justify, even when they know the long-term benefits. For payers, it reflects a short-term cost deferral strategy that appears efficient in the moment but ultimately perpetuates inequity. By prioritizing short term financial “savings”, they accrue hefty long term costs with lives lost along the way.
Trek Health and Price Transparency
By using CMS Transparency in Coverage (TiC) data alongside outcomes, Trek Health helps providers show payers the value of preventive care and build stronger cases for contracts that align with long-term health benefits. The epidemiology of breast cancer makes one thing clear: prevention works, but reimbursement doesn’t reflect that reality. Payments rise only when outcomes worsen, a system design that is both inequitable and unsustainable. If reimbursement is tied to mortality rather than prevention, inequities deepen. Trek Health equips providers with the data and tools to push for change so reimbursement can reward prevention, not just burden.
White Paper
Reimbursement and Reality: The Economics of Breast Cancer Treatment
While breast cancer awareness efforts often focus on screening and treatment, one critical factor remains overlooked: how care is reimbursed. Payment structures shape far more than provider margins; they influence access, equity, and patient outcomes.
In this analysis of payer rates, Trek Health uses its Transparency Platform to analyze how reimbursement for breast cancer care varies across geography, commercial payer behavior, and public policy. The findings reveal a system that rewards disease burden rather than prevention which creates inequities that ripple through the entire care process.
Inside you’ll learn:
- How reimbursement rates differ dramatically by state and payer
- Why higher disease burden correlates with higher payment, but prevention does not
- What these trends mean for provider strategy, patient access, and equity
Download the full analysis to see how transparency data can help reshape breast cancer care—turning financial insight into fairer outcomes.
Introduction
When it comes to breast cancer, the evidence is overwhelming: early detection saves lives. National guidelines recommend mammograms every two years for women starting at age 40, and studies consistently show that screening improves survivability. Yet when we analyzed reimbursement data across states and payers, we found a troubling reality: reimbursement has no connection to prevention. Instead, payment increases only when outcomes worsen.
Prevention Doesn’t Pay
Our analysis confirmed that screening rates for women over the age of 40 by state were not significantly associated with reimbursement levels. States with higher uptake of mammography saw no improvement in reimbursement for providers delivering those services. The same was true for new diagnoses: the incidence of breast cancer is not significantly tied to payer reimbursement. Early detection is the foundation of most breast cancer awareness campaigns, and yet the financial incentives lag behind the marketing campaigns. Though nationally there has been steady movement toward value-based care, this reality contradicts those principles.
Value-based care is built on the idea that providers should be rewarded for keeping patients healthy, reducing avoidable hospitalizations, and improving long-term outcomes. Instead, payment still tracks with the cost of treating disease once it becomes complex, leaving prevention undervalued and misaligned with the very goals of a value-based system. As a result, systems face a structural lack of incentives to prioritize prevention, even though it is widely understood to improve outcomes and reduce long-term costs.
Healthcare Hardships Unlocks Dollars
By contrast, reimbursement increased when outcomes worsened. Mortality was assessed in two ways: as a population-adjusted mortality rate and as the proportion of patients who died relative to incidence. In both cases, states with higher mortality saw higher reimbursement. Payments rose once disease became unavoidable, when complexity and costs escalated. Payers appear more willing to compensate providers once the system is already facing advanced disease and higher acuity, rather than rewarding the work that could have reduced those outcomes in the first place. In effect, dollars are unlocked only when patients get sicker, tying financial incentives to treating late-stage complexity instead of preventing it.
The Incentive Misalignment
This creates a dangerous paradox: prevention, which saves lives and reduces long-term costs, is undervalued, while late-stage disease management is rewarded. For patients, this often means that health systems lack the financial support to expand preventive programs, leaving early detection inconsistent and uneven. For providers, it makes investing in screening and early detection financially harder to justify, even when they know the long-term benefits. For payers, it reflects a short-term cost deferral strategy that appears efficient in the moment but ultimately perpetuates inequity. By prioritizing short term financial “savings”, they accrue hefty long term costs with lives lost along the way.
Trek Health and Price Transparency
By using CMS Transparency in Coverage (TiC) data alongside outcomes, Trek Health helps providers show payers the value of preventive care and build stronger cases for contracts that align with long-term health benefits. The epidemiology of breast cancer makes one thing clear: prevention works, but reimbursement doesn’t reflect that reality. Payments rise only when outcomes worsen, a system design that is both inequitable and unsustainable. If reimbursement is tied to mortality rather than prevention, inequities deepen. Trek Health equips providers with the data and tools to push for change so reimbursement can reward prevention, not just burden.
