Payers and Providers Experiment With Oncology Payment Models

With a focus on improving quality while maintaining the cost of care, providers and payers are evaluating various payment models that could improve patient outcomes using evidence-based treatment at lower costs to the healthcare system.

Insurers and provider groups are trying a variety of approaches on oncology reimbursement that will remove the incentive for oncologists to use expensive but not necessarily effective chemotherapy drugs and instead place the focus back on quality of care.

These approaches range from care management fees paid on top of drug costs to bundled payments and case rates that completely revamp the way oncologists are reimbursed. Representatives of provider groups and insurers described three separate value-based payment programs for oncology at the Pay for Performance Summit in San Francisco sponsored by Global Health Care, LLC, on March 3.

New cancer drugs are often not cost-effective, said Jennifer Malin, MD, PhD, medical director for oncology solutions and innovation at Anthem Inc. For example, there were 13 new cancer treatments approved by the FDA in 2012, and only one of these extended survival by 6 months. Two more extended survival by four to six weeks, she said, but the average cost of treatment per month for all these therapies is $5900.

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