Alternative Payment Models

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Value-Based Care Veterans, Surprised by EOM Results, Ponder Next Move
Value-Based Care Veterans, Surprised by EOM Results, Ponder Next Move

September 11th 2025

Community oncology leaders navigate challenges in value-based care under the Enhancing Oncology Model, facing performance payment uncertainties and evolving drug markets.

Daniel C. Kendzierski, PharmD, BCOP | Image: LinkedIn
Remote Clinical Pharmacists Saved Nearly $9M, Helped Practices Meet EOM Targets

August 21st 2025

AJMC
Utilization and Costs Among Oncologists Participating in a Private Insurance Shared Savings Model

June 11th 2025

McKesson logo | Image credit: McKesson
Once Again, CMS Selects McKesson’s Practice Insights as a Qualified Clinical Data Registry

January 28th 2025

Doing Things Differently: Wilfong Moves to Thyme Care
Doing Things Differently: Wilfong Moves to Thyme Care

October 12th 2024

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What Dr Jane F. Barlow Sees in the Future for Reimbursement for High-Cost Therapies
December 13th 2018

What Dr Jane F. Barlow Sees in the Future for Reimbursement for High-Cost Therapies

The greatest unknown if which reimbursement model for these high-cost therapies will gain supremacy, explained Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology.
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December 11th 2018

Cost Variation and Savings Opportunities in the Oncology Care Model

James Baumgardner, PhD Ahva Shahabi, PhD Christopher Zacker, RPh, PhD Darius Lakdawalla, PhD
Geographic variation in cancer treatment spending reveals that chemotherapy and hospital inpatient care may offer opportunities for savings for practices participating in the Oncology Care Model.
Dan Mendelson: How the Shift to Value-Based Care Is Impacting Managed Care Pharmacy
December 10th 2018

Dan Mendelson: How the Shift to Value-Based Care Is Impacting Managed Care Pharmacy

Dan Mendelson, MPP, founder, Avalere Health, discusses how the shift to value-based care has impacted managed care pharmacy.
What Might Come After the Oncology Care Model
December 10th 2018

What Might Come After the Oncology Care Model

Laura Joszt, MA
While the Oncology Care Model is likely not a sustainable mode for oncology care, it will probably inform what payment structure comes next.
Dr Sibel Blau Outlines Changes to Her Practice to Prepare for OCM
December 6th 2018

Dr Sibel Blau Outlines Changes to Her Practice to Prepare for OCM

Years before the Oncology Care Model (OCM) was implemented, Northwest Medical Specialties started preparing by making changes to the personnel in the practice, explained Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.
Majority of Hospitals Will Receive Incentive Payments in 2019 Hospital VBP Program
December 4th 2018

Majority of Hospitals Will Receive Incentive Payments in 2019 Hospital VBP Program

Laura Joszt, MA
In fiscal year 2019, there will be approximately $1.9 billion in value-based incentive payments available to hospitals in the Hospital Value-Based Purchasing (VBP) Program, which is a budget-neutral program.
Delay in Performance Period Results Challenges Practices Participating in OCM
November 28th 2018

Delay in Performance Period Results Challenges Practices Participating in OCM

Laura Joszt, MA
The lag time between the end of a performance period in the Oncology Care Model (OCM) and the release of the full report from CMS, represents a challenge for practices looking to improve.
CMS Finalizes New Structure to Move Home Health to Value-Based Payment
November 28th 2018

CMS Finalizes New Structure to Move Home Health to Value-Based Payment

Laura Joszt, MA
CMS is moving home health agencies away from a volume-based payment model and to a new value-based payment system. The Patient-Driven Groupings Model would focus on patient needs and rely more heavily on patient characteristics in order to pay for home health services.
Stephen Nuckolls: ACOs Remain the Government's Best Option to Control Healthcare Costs
November 25th 2018

Stephen Nuckolls: ACOs Remain the Government's Best Option to Control Healthcare Costs

The proposed changes to the Medicare Shared Savings Program may put a damper on the accountable care organization (ACO) movement, but ACOs remain the government’s best option for controlling healthcare costs, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
Allison Brennan Discusses Impacts of Certain Proposed Changes to the MSSP
November 24th 2018

Allison Brennan Discusses Impacts of Certain Proposed Changes to the MSSP

There are some proposed changes to the Medicare Shared Savings Program (MSSP) that may be favorably or not depending on the accountable care organization (ACO) and its situation, said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.
Humana's Investment in Holistic, Value-Based Care Improves Care and Health of MA Members
November 23rd 2018

Humana's Investment in Holistic, Value-Based Care Improves Care and Health of MA Members

Laura Joszt, MA
Chronic diseases remain a significant challenge for older Americans, and Humana is using a holistic approach, leveraging value-based reimbursement models, to improve health outcomes and quality measures for the insurer’s Medicare Advantage (MA) members, according to a new Humana report, “The Intersection of Health + Care.”
Dr Barbara McAneny: Success in OCM Seems Like a "Random Event"
November 23rd 2018

Dr Barbara McAneny: Success in OCM Seems Like a "Random Event"

Practices that had experience with the COME HOME community oncology medical home model didn’t perform any better in the Oncology Care Model (OCM) than other practices, explained Barbara L. McAneny, MD, president of the American Medical Association.
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November 17th 2018

AMA's McAneny Calls for Real-time Oncology Payment Model Led by Physicians

Mary Caffrey
In the keynote address at Patient-Centered Oncology Care® 2018, Barbara McAneny, MD, a New Mexico oncologist/hematologist and the current president of the American Medical Association (AMA), shared her diagnosis for the current crisis in US healthcare, as well as a prescription—a new real-time oncology payment model led by physicians.
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November 16th 2018

Keeping Ahead of the Curve in the Transition to Oncology Value-Based Payment

Christina Mattina
At a session of The American Journal of Managed Care®'s Patient-Centered Oncology Care® 2018 meeting, held November 16 in Philadelphia, panelists shared their views on the future of oncology value-based payment models and how they as payers and providers can help advance these models.
This Week in Managed Care: November 16, 2018
November 16th 2018

This Week in Managed Care: November 16, 2018

This week, the top managed care news included research that showed c​​​​ancer surpassed cardiovascular disease to be the leading cause of death in high-income counties; HHS Secretary Alex Azar announced a new mandatory payment model is coming to oncology; a policy change could make mental health treatment more available.
The New Oncology Bundle Model: What We Know and Don't Know
November 15th 2018

The New Oncology Bundle Model: What We Know and Don't Know

Darcie Hurteau
CMS' announcement of a new mandatory oncology bundled payment model wasn't a surprise. It reinforces CMS' continued commitment to creating innovative ways of transforming care.
Data and Collaboration Are Key for Value-Based Care Success
November 11th 2018

Data and Collaboration Are Key for Value-Based Care Success

Laura Joszt, MA
Data and collaboration are necessary ingredients to succeed in the transition to value-based care models, and the money saved under these models will create room to pay for unconventional therapies and services in healthcare, according to panelists at The Institute for Value-Based Medicine meeting in Seattle, Washington.
Allison Brennan Outlines the Greatest Challenges of the Proposed MSSP Changes
November 11th 2018

Allison Brennan Outlines the Greatest Challenges of the Proposed MSSP Changes

The shorter timeline to risk and the reduction of shared savings rates are among the 2 greatest challenges accountable care organizations (ACOs) will face as part of the proposed changes to the Medicare Shared Savings Program (MSSP), said Allison Brennan, MPP, senior vice president of government affairs for the National Association of ACOs.
Stephen Nuckolls Discusses What May Change Under the Proposed Pathways to Success
November 10th 2018

Stephen Nuckolls Discusses What May Change Under the Proposed Pathways to Success

While the proposed changes to the Medicare Shared Savings Program (MSSP) won’t mean a large number of changes to Coastal Carolina Quality Care, the accountable care organization will have to make some changes to respond to the new Enhanced track, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.
Saving Costs While Maintaining Quality of Care—The Value of Biosimilars in Oncology
November 8th 2018

Saving Costs While Maintaining Quality of Care—The Value of Biosimilars in Oncology

Surabhi Dangi-Garimella, PhD
According to a review published in Cancer Management and Research, biosimilar products present a viable cost-saving tool for providers participating in value-based care programs such as the Medicare Shared Savings Program or the Oncology Care Model.
Dr Katherine Schneider: MSSP Proposed Changes Will Be a Step Back on Path to Value
November 7th 2018

Dr Katherine Schneider: MSSP Proposed Changes Will Be a Step Back on Path to Value

The proposed changes to the Medicare Shared Savings Program could prevent the program from driving broad change to value-based care across the country, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
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November 1st 2018

Learnings From Priority Health's Oncology Payment Reform Model

Surabhi Dangi-Garimella, PhD
To speak about the success and continued development of Priority Health's payment reform model in cancer care, John Fox, MD, medical director at Priority Health, joined Dennis Zoet, chief business development officer at Cancer and Hematology Centers of Western Michigan, on a panel at the Community Oncology Alliance Payer Exchange Summit.
Oregon Approves Policies to Continue Value-Based Care Push in Medicaid
October 31st 2018

Oregon Approves Policies to Continue Value-Based Care Push in Medicaid

Laura Joszt, MA
Oregon has approved new policies to continue the transformation of its Medicaid program with a focus on behavioral health, value, and social determinants of health in the state's coordinated care organizations.
Dr Clif Gaus Discusses Measuring MSSP ACOs Savings
October 31st 2018

Dr Clif Gaus Discusses Measuring MSSP ACOs Savings

There are different ways to measure how Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) have saved money, and the way used can drastically affect the amount of savings reported, explained Clif Gaus, ScD, president and CEO of the National Association of ACOs.
Dr Rob Fields: Proposed MSSP Changes Likely to Stifle ACO Movement, Increase Consolidation
October 30th 2018

Dr Rob Fields: Proposed MSSP Changes Likely to Stifle ACO Movement, Increase Consolidation

Systems, groups, and practices that haven’t yet joined the accountable care organization (ACO) movement will find it harder to do so if the proposed changes to the Medicare Shared Savings Program (MSSP) take effect, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.
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October 30th 2018

COA's OCM 2.0: Moving Toward a Universal Payment Model

Surabhi Dangi-Garimella, PhD
The Community Oncology Alliance (COA) has been working with its member practices and some payer partners who have successfully implemented innovative care delivery and payment models to develop a 2.0 version of CMS’ Oncology Care Model (OCM). A progress report was presented at COA’s Payer Exchange Summit held October 29-30 in Tyson’s Corner, Virginia.
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October 30th 2018

Community Practices Continue to Struggle With ED Use, Risk Stratification in OCM

Surabhi Dangi-Garimella, PhD
While practice transformation is vital, community-based clinics continue to struggle with emergency department (ED) use, hospitalization, and risk stratification as they identify ways to reduce unnecessary expenditures within their Oncology Care Model (OCM) practice.
Implications of OCM Reports and the Future of the Program
October 29th 2018

Implications of OCM Reports and the Future of the Program

Laura Joszt, MA
Lalan Wilfong, MD, moderated a conversation between Robert E. Baird, MD, CEO of Dayton Physicians Network, and Sarah Cevallos, chief revenue cycle officer for Florida Cancer Specialists and Research Institute, about current and future strategies for Oncology Care Model (OCM) participation, as well as key lessons from the OCM and how they can be applied in other reform models.
Dr Katherine Schneider Highlights How Proposed MSSP Changes Build Stability Into Program
October 27th 2018

Dr Katherine Schneider Highlights How Proposed MSSP Changes Build Stability Into Program

The proposed changes to the Medicare Shared Savings Program (MSSP) acknowledge the complexity of the program and bring more predictability and stability to MSSP, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
Dr Barbara McAneny Discusses the Effect of OCM's Second Performance Period Results
October 24th 2018

Dr Barbara McAneny Discusses the Effect of OCM's Second Performance Period Results

Practices that did not meet cost-savings goals in either the first or second performance periods of the Oncology Care Model (OCM) will likely leave the program, said Barbara L. McAneny, MD, president of the American Medical Association.
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