Making Cancer Support Services Sustainable in Value-Based Care

Over the past decade, the oncology community has generated a tremendous amount of evidence on the multitude of benefits of embedding supportive health care delivery interventions within clinical workflows of oncology providers.^1-5 Despite the undeniable improvements in cost, quality, and patient experience, these programs, including formalized lay navigation and psychosocial support as well as proactive symptom evaluation with protocolized nurse triage services, are difficult to sustain and scale in our legacy fee-for-service system, particularly for community oncology practices.

First and foremost, oncology practices lack the capital to invest in additional staff, information technology, and change management to optimize and maintain this type of supportive care program. Even with new Medicare reimbursement for a handful of these services, the attainable revenue from these codes falls well short of the cost to stand up the program and deliver the services. Practices must find other ways to finance these services, typically by cross-subsidization of drug revenue or through philanthropy, while the financial benefits accrue to the payers in the form of spend reduction.

Although oncology practices are doing everything in their power to meet the needs of their complex patient population, the practical reality is that this incentive misalignment threatens the feasibility of providing essential services to patients when they need them. Making matters worse, practices are facing increasingly significant financial headwinds from continued reductions in cancer drug reimbursement from both commercial payers and Medicare via the Inflation Reduction Act.

Value-based payment models, such as the Oncology Care Model and its successor, the Enhancing Oncology Model,^6,7 were a step in the right direction to address and overcome this misalignment. Unfortunately, foundational structural issues limited their ability to demonstrate value to all stakeholders.

These issues include actuarial instability due to small subpopulations and limited cancer types, the disproportionate share of total spend attributed to systemic therapy, short model duration, excessive downside financial risk to practices, data and reporting lags, and shortcomings of the financial adjustment methodology. Despite practices gaining valuable experience implementing new programs and shifting culture toward a value-based framework, practices are abandoning these episodic models that focus only on the active treatment phase. Even so, the oncology community remains eager for novel value-based models that effectively facilitate the growth and sustainability of critical, evidence-based, supportive care services within the context of their clinical workflows.

This value-based paradigm shift has created both new opportunities and challenges. The oncology care delivery ecosystem is increasingly rife with primarily virtual-first care delivery solutions and partnership opportunities that help oncology practices deliver these services in a more financially viable way. If desired, practices can outsource or form partnerships to deliver any number of the many care management services that qualify for fee-for-service reimbursement, such as principal illness navigation, chronic care management, primary care management, collaborative care management, assessment and coordination of social determinants of health, remote patient monitoring, and remote symptom monitoring.

Although these arrangements present a new opportunity, practices must navigate the decision about which interventions to invest in that deliver internally and what can be delivered through outsourcing or partnerships.

Practices are faced with evaluating a multitude of companies, each with its own models, tools, and approaches, all with their own clinical and financial trade-offs. For example, opting for an out-of-the-box, remote, payer-driven solution may require minimal lift from the oncology practice and provide some incremental revenue. However, patient engagement and impact may be limited if patients do not consider the intervention to come directly from their oncologist or if they are unclear about how it relates to their care plan. In contrast, deeply integrated care models that consider practices’ unique context and resources, are embedded with the practice workflows, and are delivered in close collaboration with the treating oncologist are much more likely to successfully engage patients and achieve desired outcomes. However, implementing these models is more resource intensive and requires a higher level of practice buy-in. Another key consideration is whether to deploy multiple different solutions or select a value-based enablement partner whose scope is broader and includes multiple desired services. The benefits of a broader approach include minimizing redundancy and care fragmentation, operational simplicity for providers and patients, and role clarity. Additionally, given the importance of technology integration, having a smaller number of deep partnerships maximizes the likelihood that the technology lift will be feasible.

In summary, the evidence of benefit for supportive care services is indisputable but the current reimbursement system remains a barrier to practices sustaining and growing these services on their own. Emerging solutions that fill capability gaps, minimize operational lift, shield practices from downside financial risk, address financial misalignment, and maintain a North Star of clinical quality and appropriateness are desperately needed. At Atlas Oncology Partners, we have set out to address these fundamental barriers by first aligning incentives through longitudinal, condition-based, total-cost-of-care value-based contracts with payers and then providing investments in embedded, incremental clinical services and infrastructure, information technology, population health resources, actuarial expertise, and financial capital to help oncology practices succeed in these models.

Author Information
David Johnson, MD, MPH, is chief physician executive and Gabrielle Rocque, MD, MSPH, is chief medical officer for Atlas Oncology Partners, a value-based company that offers oncology practices incremental staff, tools, and novel reimbursement contracts to deliver whole-person care to patients.

References
1. Rocque GB, Pisu M, Jackson BE, et al; Patient Care Connect Group. Resource use and Medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol. 2017;3(6):817-825. doi:10.1001/jamaoncol.2016.6307

2. Patel MI, Kapphahn K, Dewland M, et al. Effect of a community health worker intervention on acute care use, advance care planning, and patient-reported outcomes among adults with advanced stages of cancer: a randomized clinical trial. JAMA Oncol. 2022;8(8):1139-1148. doi:10.1001/jamaoncol.2022.1997

3. Patel MI, Ramirez D, Agajanian R, Agajanian H, Bhattacharya J, Bundorf KM. Lay health worker-led cancer symptom screening intervention and the effect on patient-reported satisfaction, health status, health care use, and total costs: results from a tri-part collaboration. JCO Oncol Pract. 2020;16(1):e19-e28. doi:10.1200/JOP.19.00152

4. Basch E, Schrag D, Henson S, et al. Effect of electronic symptom monitoring on patient-reported outcomes among patients with metastatic cancer: a randomized clinical trial. JAMA. 2022;327(24):2413-2422. doi:10.1001/jama.2022.9265

5. Rocque GB, Franks JA, Deng L, et al. Remote symptom monitoring with electronic patient-reported outcomes in clinical cancer populations. JAMA Netw Open. 2025;8(5):e259852. doi:10.1001/jamanetworkopen.2025.9852

6. Oncology Care Model. CMS. Updated June 22, 2022. Accessed March 30, 2026. https://www.cms.gov/priorities/innovation/innovation-models/oncology-care

7. Enhancing Oncology Model. CMS. Updated March 20, 2026. Accessed March 30, 2026. https://www.cms.gov/priorities/innovation/innovation-models/eom