Dr Basit Chaudhry: Commercial Payers Are Expected to Start Aligning More With Medicare

December 26, 2020

SAP Partners | <b>Quality Care Cancer Alliance (QCCA)</b>

There is a lot of variation among commercial payers, but broadly speaking they are expected to start moving to adopt what Medicare does, said Basit Chaudhry, MD, PhD, founder of Tuple Health.

There is a lot of variation among commercial payers, but broadly speaking they are expected to start moving to adopt what Medicare does, said Basit Chaudhry, MD, PhD, founder of Tuple Health.

Transcript

What have we seen among commercial payers? How are they changing reimbursement following the implementation of OCM, and the planned moved to OCF?

So, on the commercial side, I think it's an interesting landscape. It varies quite a bit regionally. Because I think we have national carriers who have, I think, for the most part, pretty much all of them have some kind of initiative in cancer care. And there's much more variation regionally, particularly amongst different state plans, that different practices, you know, are located with that.

I think, broadly speaking, we're going to see increasing, kind of, not standardization—I think we're going to see a movement towards adopting what Medicare does as a kind of at least directional point for what commercial payers do. So, for instance, to date, many of the commercial payment models in cancer care have not been risk adjusted. I think, you know, we will see, because that's been a significant part of Medicare models, we'll see things structurally like that get reorganized and realigned. I think there's been a number of, you know, initiatives that have moved in that way. I think the more recent UnitedHealthcare model, for instance, I think has a number of structural overlaps with some of the things that’ve been done on the Medicare side. So, I think if you want to look at future commercial, I think learning from what's happening in Medicare is probably a safe bet to do that.