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Payment Reform in Cancer Needs to Engage and Reward Patients, Experts Assert

Laura Joszt
Payment reform efforts that don't engage patients are missing out on an opportunity for greater improvements, especially in cancer, where patients face substantial cost sharing.
Payment reform efforts that don’t engage patients are missing out on a beneficial opportunity, according to a Viewpoint published in JAMA Oncology.

S. Yousuf Zafar, MD, of Duke Cancer Institute; Blase N. Polite, MD, MPP, of the University of Chicago Medicine; and Mark McClellan, MD, of Duke-Margolis Center for Health Policy, argue in the piece that new payment models that focus on making patients active participants in their health could prove to be more successful in encouraging higher-value care.

So far, explained the authors, payment reform efforts looking to improve quality of care and reduce costs have focused on encouraging practitioners and healthcare organizations. However, they noted that patients with cancer, who are facing high cost sharing, would benefit from “opportunities to share in the benefits of high-value practice.”

The authors highlighted 2 main opportunities to engage and support patients that are currently being missed.
  1. Patient choice of where to receive care. While practices participating in the Oncology Care Model (OCM) report and receive quality metrics, there is no mandate to provide that data to patients. If patients could have access to quality measurement and reporting data, it might mean high-performing practices would get more patients and more revenue.
  2. Engaging patients to take an active role in their care. Value-based payment models often focus on aspects of care that practices might have trouble impacting if patients choose to alter their behavior. In addition, efforts to improve adherence only work if patients are engaged. “Patients who actively engage in their care should be able to earn financial benefits for doing so,” the authors wrote.
Zafar, Polite, and McClellan have a few suggestions, such as shifting measure reporting to focus on patient-centered quality measures. Another option is creating a payment for Medicare beneficiaries who align care with an advanced OCM practice—practices that achieve significant savings would share them with the beneficiaries.

They also recommend extending the Medicare Advantage Value-Based Insurance Design to cancer. The pilot, which allows insurers to offer lower co-payments for high-value services or drugs, is only available for a limited set of chronic conditions.

“Enabling patients with cancer to share in the same kinds of financial benefits as health care organizations provides powerful opportunities for this engagement,” the authors concluded.


Zafar SY, Polite BN, McClellan M. Engaging patients in value-based cancer care: a missed opportunity. [published online August 02, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2018.2826.

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