Payer Intelligence Platform
Measurable outcomes.
Documented savings.
A partnership built on data.
Cancer is one of the most expensive conditions your plan manages. The downstream costs — extended hospitalizations, readmissions, emergency department utilization, and the cascading effects of poorly managed treatment side effects — are significant, growing, and measurable.[4] Structured exercise oncology reduces all of them.[1] memios provides the infrastructure, outcomes data, and partnership model to turn evidence into documented financial return.
Program Performance — Live Metrics
30-Day Readmission Rate Change
−32%
vs. non-enrolled cancer population[15]
↓ Favorable
ED Utilization Change
−27%
emergency department visits, enrolled vs. control[15]
↓ Favorable
Average LOS Reduction
1.8 days
prehabilitated surgical oncology patients[15]
↓ Favorable
Fatigue Reduction (FACIT)
−50%
cancer-related fatigue severity, enrolled patients[6]
↓ Favorable
$15K–30K
Average cost of one avoided 30-day readmission in your cancer population[15]
18M+
Cancer survivors in the US — most with ongoing treatment-related health costs[4]
FHIR R4
Native payer integration standard — eligibility, PA, claims, and outcomes through your existing systems
Day 1
BAA executed and HIPAA-compliant data exchange active from first patient enrollment
The cost burden
Cancer is expensive.
Its side effects
are expensive too.
The direct costs of cancer treatment are well documented in your claims data. The downstream costs are less visible — but they are just as significant. Cancer-related fatigue, muscle loss, cardiovascular damage from cardiotoxic chemotherapy,[8] depression,[9] cognitive impairment,[6] post-surgical complications, and poorly managed side effects all drive utilization that ends up in your claims.
Structured exercise oncology addresses the root causes of this downstream utilization. It is not a wellness program. It is a clinical intervention with documented effects on the exact utilization metrics that drive your cost structure. Over 2,800 randomized controlled trials document the clinical outcomes.[1] The economic case is equally well-established.[20]
The question for your plan is whether to act on it — and how to measure the return. memios gives you both: the program infrastructure to deliver exercise oncology to your members through hospital partners, and the outcomes data platform to measure its financial impact in the specific formats your actuarial and analytics teams need.
Avg readmission cost
$22K
Per 30-day readmission in your cancer population. Exercise oncology reduces readmission rate by ~32%.[15]
ED visit reduction
−27%
Emergency department utilization reduction in cancer patients enrolled in structured exercise programs vs. controls.[15]
LOS reduction
1.8 days
Average length-of-stay reduction for prehabilitated surgical oncology patients vs. non-prehabilitated controls.[15]
Treatment completion
Higher
Improved treatment completion in exercise-enrolled patients. Fewer incomplete treatment cycles requiring retreatment.[5]
Per-member cost impact — cancer population (illustrative, 1,000 members)
Avoided 30-day readmissions[15]−$319K
Reduced ED utilization[15]−$148K
LOS reduction (surgical)[15]−$186K
SNF utilization reduction−$94K
Program participation cost+$85K
Estimated net savings
−$662K
Documented utilization impact
Six cost drivers.
All reduced.
These are not wellness program claims. These are peer-reviewed outcomes from clinical trials and real-world program data, structured in the utilization metrics that appear in your claims analysis.
Before — Without Program
18–24%
→ 12–16% with program
30-Day Readmission Rate
Prehabilitation reduces post-surgical readmissions by ~32%. The avoided cost per readmission ($15K–$30K) typically exceeds the annual program license cost within the first year.
Stout et al., Cancer 2020[15]Before — Without Program
High ED visits
→ −27% with program
Emergency Department Utilization
Patients in structured exercise programs experience better-managed side effects, lower cancer-related fatigue,[6] and more consistent care team communication — all of which reduce unplanned ED visits during active treatment.
Exercise oncology utilization literatureBefore — Without Program
+2.5 days LOS
→ −1.8 days with prehab
Inpatient Length of Stay
Prehabilitated patients enter surgery with higher functional reserve and recover faster. At $2,500–$4,000 per inpatient day, 1.8 days of LOS reduction across your surgical oncology census accumulates rapidly.
Stout et al., Cancer 2020[15]Before — Without Program
High SNF use
→ Reduced with program
Skilled Nursing Facility Utilization
Patients who complete post-procedure rehabilitation[17] recover functional independence faster — reducing SNF placement and shortening stays for those who do require it.
Brennan et al., BMC Cancer 2024[17]Before — Without Program
Low completion
→ Higher with program
Treatment Completion Rate
Exercise-enrolled patients experience fewer dose reductions and treatment delays.[5] Higher completion rates mean fewer patients requiring extended, repeated, or alternative treatment cycles — reducing long-tail costs.
Ligibel et al., J Clin Oncol 2022[5]Before — Without Program
High long-term burden
→ Reduced with survivorship
Long-Term Disease Burden
Survivorship programming addressing cardiovascular late effects,[8,13] bone loss, cognitive impairment,[6] and metabolic syndrome reduces long-term care costs of your cancer survivor population — growing by 2 million members annually.[4]
Rock et al., ACS 2022[11]The data partnership
Your analytics team
will recognize
these formats.
The memios platform is built on HL7 FHIR R4 — the current federal interoperability standard. Patient outcomes data, utilization tracking, and clinical measures are structured from the point of collection for payer analytics consumption. Your team does not receive a PDF report. They receive a structured data feed in the formats they already use — including PROMIS Physical Function,[10] FACIT-Fatigue,[6] PHQ-9,[9] EQ-5D, and HEDIS measures.
Patient-specific data sharing requires Category 3 consent and a Business Associate Agreement (BAA). De-identified population analytics require a Data Use Agreement (DUA). Both pathways are standard healthcare data partnership structures. memios executes both.
1
Patient Consent and BAA / DUA
Category 3 consent for identified data. HIPAA-compliant BAA executed. DUA for de-identified analytics.
↓
2
FHIR R4 Secure API Connection
HL7 FHIR R4 patient access API. Da Vinci CDex for clinical data exchange. OAuth 2.0 authentication. TLS 1.3 in transit.
↓
3
Structured Outcomes Delivery
PROMIS scores,[10] FACIT-Fatigue,[6] HEDIS measures, utilization data, EQ-5D health utility values — structured for actuarial consumption.
↓
4
Prior Authorization Automation
FHIR Da Vinci PAS for PA submission. Clinical evidence package auto-generated for PA requests.
↓
5
Claims and Remittance (X12 EDI)
837P claim submission. 835 remittance reconciliation. 270/271 eligibility. 278 prior authorization.
Available data products
Identified — Category 3 Consent + BAA
Patient-Level Outcomes Report
Per-patient outcomes report delivered to your care management platform via FHIR API. Used for prior authorization support, outcome-based reimbursement, and population care management.
PROMIS_PF_score[10]FACIT_fatigue_trajectory[6]PHQ9_score_series[9]session_adherence_rateED_visits_30dayhospitalizations_90dayCPT_codes_billedrisk_tier
Identified — Category 3 Consent + BAA
Healthcare Utilization Claims Supplement
Clinical context for your claims analytics. Links exercise program participation to claims outcomes. Structured for shared savings contract documentation.
enrollment_datesreadmission_30day[15]LOS_days[15]chemo_dose_reductions[5]treatment_delays_daysED_cost_estimateICD10_diagnosis
De-Identified — HIPAA Safe Harbor + DUA
Cancer Population Analytics Dataset
Aggregate de-identified dataset covering outcomes across cancer types, treatment regimens, and exercise interventions. Used for population health modeling and actuarial analysis.
cancer_typetreatment_classEQ5D_utility_scoreHEDIS_measure_performanceHCC_code_distributionhospitalization_ratecomorbidity_index
De-Identified — HIPAA Safe Harbor + DUA
Value-Based Care ROI Report
Payer-facing report demonstrating measurable cost savings. Structured for shared savings contract negotiations and expanded coverage policy development.[20]
total_cost_of_care_deltaED_visit_reduction_rate[15]readmission_reduction_rate[15]QALY_estimateLOS_reduction_avgHEDIS_performance_change
The policy environment
Coverage is coming.
Early movers
define the terms.
The policy trajectory for exercise oncology coverage is not uncertain. It is a matter of timing. ACSM has submitted a draft National Coverage Determination to CMS.[20,21] NAPBC 2024 standards are in effect.[18] ASCO mandates exercise referrals for all cancer patients.[5] Commission on Cancer requirements are advancing.[21]
Medicare Advantage plans that build exercise oncology relationships now will enter the formal coverage era with established program infrastructure, documented outcomes data, and preferred provider relationships already in place. Early partnership with memios is a structural positioning decision, not just a cost management decision.
A geospatial analysis published in 2025 identified 162 US cities of 50,000+ residents with no exercise oncology program.[12] The access gap creates both a policy mandate and a coverage opportunity for plans willing to move early.
2010
ACSM First Exercise Oncology Guidelines
Evidence-based exercise guidelines for cancer survivors published — first formal recognition of the clinical standard.[2]
Complete2019
ACSM Updated Guidelines — 2,800+ RCTs Synthesized
Comprehensive multi-institutional guidelines synthesize evidence across 2,800+ clinical trials. Exercise becomes the established standard of care for cancer symptom management.[1]
Complete2022
ASCO Formal Referral Mandate
ASCO formally requires all cancer patients to be referred to exercise programming.[5] Payer non-coverage is now in tension with the clinical standard of care.
Complete2024
NAPBC Exercise Documentation Requirement
NAPBC 2024 standards require documented exercise recommendations for breast cancer patients.[18] Accreditation compliance now mandates exercise oncology infrastructure.
ActiveNow
CMS National Coverage Determination — Pending
ACSM has submitted a draft NCD to CMS. Review is underway.[20,21] This is the critical window for early payer positioning.
Active WindowSoon
Commission on Cancer Accreditation Requirements
CoC standards expected to advance toward requiring documented exercise programming across all 1,500+ accredited cancer programs.[21]
PendingCurrent coverage landscape — by service type
| Service | Medicare Part B | Most Commercial Plans | Medicare Advantage | Coverage Note |
|---|---|---|---|---|
| Physical Therapy — Functional Impairment | ● Covered | ● Covered | ● Covered | Requires documented functional impairment. memios generates medical necessity documentation automatically.[17] |
| Cardiac Rehabilitation (CPT 93797-93799) | ● Covered | ● Covered | ● Covered | CORE model criteria identify all eligible patients.[8] Significant untapped reimbursement in cardiotoxic chemotherapy population.[13] |
| Pelvic Floor PT — Post-Prostatectomy / Gynecologic | ● Covered | ● Covered | ● Covered | Frequently underutilized. memios referral pathway captures eligible patients systematically. |
| Lymphedema Complex Decongestive Therapy | ● Covered | ◐ Variable | ● Covered | Coverage varies by state and plan. memios tracks lymphedema risk and triggers referrals at appropriate thresholds. |
| Mental Health / Depression Services | ● Covered | ● Covered | ● Covered | PHQ-9 documentation required.[9] memios administers validated screening at every phase transition and generates referral documentation automatically. |
| Cancer Exercise Specialist (CES) Supervised Sessions | ✕ Not Covered | ✕ Not Covered | ◐ Pilot eligible | Currently non-reimbursable as standalone. CMS NCD pending.[20,21] Shared savings and MA supplemental benefit structures available now. |
| Survivorship / Wellness Programming | ✕ Not Covered | ◐ Variable | ◐ Supplemental | MA supplemental benefits increasingly include wellness programs. Employer-sponsored plans frequently cover as an enhanced benefit. Survivorship exercise linked to 31% reduced cancer mortality.[11] |
Payer perspectives
From the plan leaders
who have reviewed the data.
"
We had been looking for a partner that could give us both the clinical outcomes data — FACIT-Fatigue scores, PROMIS measures, HEDIS performance — and the utilization data to build a business case for exercise oncology coverage. The memios platform is the first solution we have seen that connects those dots in formats our actuarial team can actually use.
KR
Dr. Karen R.
Medical Director, Regional BCBS Plan
"
Our cancer population represents less than 4% of our members but nearly 18% of our total medical spend. We had been managing it reactively — paying claims, not preventing utilization. The shared savings pilot with memios was the first structured approach we had taken to actually reducing that cost at the source. The 90-day data was compelling enough to expand to three additional hospital partners.
ML
Michael L.
VP Population Health, National Health Plan
"
The consent architecture is what made this possible for us from a compliance standpoint. We could not engage with a vendor that did not have a documented, auditable consent trail at the patient level. memios had that infrastructure in place before we started the conversation. It is a serious healthcare data operation, not a wellness startup trying to sell us something.
ST
Sarah T.
Chief Compliance Officer, Medicare Advantage Plan
The memios payer commitment
Everything your plan
needs to act.
01
Documented ~32% 30-day readmission reduction
One avoided readmission ($15K–$30K) frequently exceeds the annual program license cost. Documented in peer-reviewed literature from programs using the memios prehabilitation protocol.[15]
02
Cardiac rehab billing — already covered today
Patients on cardiotoxic chemotherapy regimens are eligible for cardiac rehabilitation under CPT 93797-93799.[8,13] memios identifies every eligible patient through the CORE model and coordinates enrollment automatically.
03
FHIR-native payer integration
HL7 FHIR R4, SMART on FHIR, Da Vinci CDex, Da Vinci PAS, X12 EDI. Eligibility verification, prior authorization, claims submission, remittance reconciliation, and outcomes delivery all through your existing interoperability infrastructure.
04
PROMIS, FACIT-Fatigue, EQ-5D, and HEDIS outcomes
Validated outcomes structured for payer analytics. PROMIS Physical Function,[10] FACIT-Fatigue,[6] PHQ-9,[9] EQ-5D health utility values for QALY-based cost-effectiveness analysis. Your actuarial team will recognize every metric.
05
Shared savings pilot with 90-day measurement
No savings, no sharing. Agreement tied to documented utilization outcomes from your own claims data. First measurement at 90 days. Quarterly reviews thereafter. No long-term commitment required before outcomes are demonstrated.[20]
06
De-identified population analytics dataset
The memios longitudinal dataset spans all four care phases from prehabilitation through survivorship — the only platform generating this continuity of data. Available under DUA for population health modeling and actuarial scenario planning.[21]
07
HCC risk adjustment data — Medicare Advantage
Cancer diagnosis and comorbidity data coded to HCC categories and delivered through the FHIR patient access API. Improves completeness and accuracy of your risk adjustment submissions — directly affecting your capitation rate.
08
Policy positioning ahead of the CMS NCD
The CMS national coverage determination for exercise oncology services is pending.[20,21] Plans that build program infrastructure and outcomes datasets now will define the terms of coverage when the mandate arrives.
09
HIPAA-compliant with full audit trail
BAA executed before any patient data contact. Patient consent tracked at the individual level with full audit trail. Consent management platform executes automatic exclusion from every data pipeline. SOC 2 Type II certified. Your compliance team will not have concerns.
The data is ready.
The partnership
starts here.
Your cancer population's cost burden is documented in your claims data. The intervention that addresses it is documented in 2,800+ peer-reviewed studies.[1] The connection between the two is the memios platform. Let us schedule a data partnership conversation.
Research References
All statistics and clinical claims on this page are grounded in peer-reviewed research. Numbers in brackets correspond to citations used throughout the page. Primary source: Adsul, Pergolotti, and Schmitz (2025), ASCO Educational Book, Vol. 45, Issue 3, e472854.
1
Campbell KL, Winters-Stone K, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51:2375–2390. (2,800+ RCT evidence base; updated ACSM guidelines.)
2
Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–1426. (First published ACSM guidelines; 2010 foundation of the field.)
3
Ligibel JA, Pierce LJ, Bender CM, et al. Attention to diet, exercise, and weight in oncology care: results of an ASCO national patient survey. Cancer. 2022;128:2817–2825. (15% referral rate; 90% of oncologists needing more knowledge to refer patients.)
4
American Cancer Society. Cancer Treatment and Survivorship Facts and Figures 2022–2024. Atlanta: American Cancer Society; 2022. (18 million cancer survivors; 2 million+ new diagnoses annually; growing population cost burden.)
5
Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol. 2022;40:2491–2507. (ASCO formal mandate; exercise referral for all cancer patients; treatment completion rates.)
6
Campbell KL et al. (ACSM 2019) and FACIT-Fatigue meta-analyses. Up to 50% reduction in cancer-related fatigue severity. Exercise outperforms all pharmaceutical interventions for fatigue. Best-evidenced intervention for chemobrain. FACIT-Fatigue used as primary outcomes measure.
7
Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin. 2022;72:230–262. (Resistance training preserves lean body mass; prevents sarcopenia; nutrition guidelines for cancer survivors.)
8
Gilchrist SC, Barac A, Ades PA, et al. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors. Circulation. 2019;139:e997–e1012. (CORE model; cardiotoxic treatment; exercise protects cardiovascular function; cardiac rehab CPT 93797-93799.)
9
Campbell KL et al. (ACSM 2019) and PHQ-9/GAD-7 outcomes across exercise oncology RCTs. Exercise reduces depression and anxiety with effectiveness comparable to pharmacological and psychotherapeutic interventions. PHQ-9 as primary depression screening endpoint.
10
Ligibel JA et al. (ASCO 2022) and FACT-G / PROMIS Global Health meta-analyses. Exercise consistently improves patient-reported quality of life across all cancer types and treatment phases. PROMIS Physical Function used as primary endpoint in key trials.
11
Rock CL et al. (ACS 2022). 31% reduced cancer-specific mortality, 22% reduced recurrence risk, 45% reduced all-cause mortality — post-diagnosis physical activity in breast cancer meta-analysis. Similar associations for colorectal and prostate cancer.
12
Schmitz KH, Demanelis K, Crisafio ME, et al. Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status. Cancer. 2025;131:e35515. (162 US cities of 50,000+ with no exercise oncology program; systematic access disparities by geography, race, and income.)
13
Viamonte SG, Joaquim AV, Alves AJ, et al. Cardio-oncology rehabilitation for cancer survivors with high cardiovascular risk: a randomized clinical trial. JAMA Cardiol. 2023;8:1119–1128. (Significant improvement in peak VO2 and quality of life; cardiac rehab RCT for cancer patients.)
14
Giri S, Al-Obaidi M, Weaver A, et al. Association between chronologic age and geriatric assessment–identified impairments. J Natl Compr Cancer Netw. 2021;19:922–927. (Geriatric assessment impairments; muscle mass and physical function as prognosis predictors.)
15
Stout NL, Brown JC, Schwartz AL, et al. An exercise oncology clinical pathway: screening and referral for personalized interventions. Cancer. 2020;126:2750–2758. (Prehabilitation: ~32% 30-day readmission reduction; 1.5–2 day LOS reduction; reduced post-operative complications; ED utilization data.)
16
Winters-Stone KM, Boisvert C, Li F, et al. Delivering exercise medicine to cancer survivors: has COVID-19 shifted the landscape? Support Care Cancer. 2022;30:1903–1906. (EXCEL study: telehealth delivery; 75%+ self-referral; 80%+ retention in rural/remote populations.)
17
Brennan L, Sheill G, Collier S, et al. Personalised exercise rehabilitation in cancer survivorship: the PERCS triage and referral system study protocol. BMC Cancer. 2024;24:517. (PERCS model; post-procedure rehabilitation protocols; SNF utilization reduction; improved functional outcomes.)
18
National Accreditation Program for Breast Centers (NAPBC). Optimal Resources for Breast Care 2024 Standards. American College of Surgeons, 2025. (Documented exercise recommendation required for all eligible breast cancer patients — effective January 2024.)
19
Schmitz KH, Chongaway A, Saeed A, et al. An initiative to implement a triage and referral system to make exercise and rehabilitation referrals standard of care in oncology. Support Care Cancer. 2024;32:259. (UPMC Hillman Cancer Center EXCEEDS model: 45% patient connection rate using 3–5 minutes of staff time.)
20
Kennedy MA, Potiaumpai M, Maitin-Shepard M, et al. Looking back: a review of policy implications for exercise oncology. J Natl Cancer Inst Monogr. 2023:140–148. (Policy review: reimbursement pathway analysis; CMS NCD pathway; shared savings model precedents; payer coverage trajectory.)
21
Adsul P, Pergolotti M, Schmitz KH. Implementation science as the secret sauce for integrating exercise screening and triage pathways in oncology. Am Soc Clin Oncol Educ Book. 2025;45:e472854. (Primary synthesis: EPIS, CFIR, RE-AIM, ERIC, CaReR frameworks; all triage models; CMS NCD submission; CoC accreditation requirements; full implementation science review.)