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Dr Thomas Graf: Personalizing Cancer Care Payment Models

Thomas Graf, MD, chief medical officer and vice president, Horizon Blue Cross Blue Shield of New Jersey, discusses evolving care bundle payments to better accommodate cancer patients.

Thomas Graf, MD, chief medical officer and vice president, Horizon Blue Cross Blue Shield of New Jersey, discusses evolving care bundle payments to better accommodate cancer patients.


How can the patient-centered medical home model provide consistent high-quality care for patients, and how will novel therapies affect it?

In some sense, this isn’t a PCMH model. These patients aren’t being addressed by primary care doctors or family physicians. They are generally being treated by oncologists. One approach is the oncology medical home model, which is basically medical home for active cancer treatment patients, and that’s one approach to this, and CMS has found a way to incorporate new very expensive drug treatments into their model, which is helpful. I think the other approach that might be more amenable to this novel therapy issue are episodes of care bundled payment where we really focus on bundles and the delivery of care for a defined period. The challenge there is unlike heart failure or COPD or joint replacement, the variation from patient to patient, member to member, is significant.

Cancer, specifically lung cancer, is not a lung cancer is not a lung cancer. So, being able to precisely define the patient and understand the clinical differences that they have and create what we call precision models, maybe phenotypically driven, maybe more likely genotypically driven, or most likely a combination of both, will be critical. Instead of having one lung cancer bundle there might be a dozen depending on the type of treatments the patients need. Then, the patients that qualify or need or would get benefit from those high cost drugs could be included in that. For those that don’t, they would have a different price point per episode. That, I think is the beginning of the way forward. We have to wait and see how that turns out.

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