Alternative Payment Models

How Value-based Care Is Changing Radiation Oncology for the Better

The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.

The Biosimilars Initiative in British Columbia, Canada, mandated patients with certain conditions on the province’s prescription coverage plan to switch from originator etanercept to a biosimilar.

Synthesis of multistakeholder perspectives from a mixed-methods study identifies guiding characteristics for outcomes-based quality measures in future, more patient-centered alternative payment models.

With the ongoing coronavirus disease 2019 pandemic, a rising number of uninsured Americans, and a new Democratic president and Senate majority, 2021 is shaping up to be a dynamic year for health care policy.

A panel at Patient-Centered Oncology Care® 2020 discussed the challenges of a pandemic as oncology practice transformation initiatives continue on.

A discussion of the final Radiation Oncology Model; after this article went to press, CMS announced a delay until July 2021, reflecting concerns of radiation oncologists.

COVID-19 has delayed the transition to Oncology Care First, but the forthcoming model could help.

Bundled payments offer promise as a supplement to existing payment models to promote scaling up of opioid use disorder treatment using buprenorphine.

Benchmarking, accountability, bilateralism, and scalability are the 4 parameters critical to successful alternative payment models in oncology, said Aaron Lyss, MBA, director of strategy and business development at Tennessee Oncology.

CMS Administrator Seema Verma announced the update today in a blog post in Health Affairs.

Networking with other practices, sharing ideas, and getting physicians involved in the process can aid community practices moving to alternative payment models (APMs), said Michael Diaz, MD, president of Community Oncology Alliance.

The Patient-Driven Payment Model addresses perverse incentives in Medicare’s previous payment system for skilled nursing facilities, but it includes new incentives that may be problematic.

Implementing alternative payment models in oncology is a complicated process. The models are not perfect, especially the Centers for Medicare and Medicaid Services’ Oncology Care Model (OCM), although several panelists saw improvements in the proposed successor model, Oncology Care First (OCF).

This review presents a set of evidence-based outcome measures for oncology alternative payment models, drawing on evidence from existing and proposed quality measures.

The November issue of The American Journal of Managed Care® (AJMC®) included studies on a kidney disease intervention, perceptions of alternative financing models, population health screening, and more. Here are 5 findings from research published in the issue.

This study examined how Medicare Advantage plan representatives perceive the alternative financing model Pay for Success and its potential to address members’ social risk factors.

AJMC®TV interviews let you catch up on what’s new and important about changes in healthcare, with insights from key decision makers—from the clinician, to the health plan leader, to the regulator.

In a commentary adapted from the organization's official response to CMS' proposal, the author highlights potential challenges that proposed alternative payment model presents for members of the American Society for Radiation Oncology (ASTRO).

This article explores Northwestern Medicine’s decision to participate in a Medicare alternative payment model (APM) despite projected losses.

As rising drug costs continue to take up a larger portion of the total cost of care, practices in the Oncology Care Model find themselves in control of a shrinking portion of total costs, according to anecdotes from an academic medical center and a community-based practice during the National Comprehensive Cancer Network’s Policy Summit held September 12 in Washington, DC.

Physician groups have begun designing alternative payment models for their own specialties, proposing that CMS include financial risk, funding for new technologies, and legal waivers.

Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative, discusses challenges with incorporating more novel concepts of value into value assessment.

With the increasing prevalence of more expensive, potentially curative therapies, there comes the question of can we still afford expensive interventions that are that valuable, explained Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative.

R. Brett McQueen, PhD, assistant professor, Department of Clinical Pharmacy, Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado, explains how multiple-criteria decision analysis be used to aid in coverage and reimbursement decisions for high-cost, innovative therapies.

As new treatments and technologies evolve, it is very important that radiation oncologists have a new alternative payment model for reimbursement, said Shalom Kalnicki, MD, FASTRO, FACRO, professor and chairman, radiation oncology, Montefiore Einstein Center for Cancer Care and Albert Einstein College of Medicine.

Jeroen Jansen, PhD, lead scientific advisor, Open-Source Value Project, Innovation and Value Initiative, discusses challenges with today’s approaches to value assessment.

Jason Mitchell, MD, chief medical and clinical transformation officer, Presbyterian Healthcare Services, discusses the role primary care will play in the transition to value-based care.