Reply to "Transforming Oncology Care": Advancing Value, Accessing Innovation

The American Journal of Managed Care, September 2015, Volume 21, Issue 9

Patient access to innovation may be at risk as new payment models emerge in oncology.

ABSTRACT

Alternative payment models in oncology are already successfully standardizing care, curbing costs, and improving the patient experience. Yet, it is unclear whether decision makers are adequately considering patient access to innovation when creating these models, which could have severe consequences for a robust innovation ecosystem and the lives of afflicted patients. The suggested chart includes recommendations on:

  • Allowing for the adoption of new, promising therapies;
  • Promoting the measurement of patient-centered outcomes; and
  • Providing support for personalized medicine.

Am J Manag Care. 2015;21(9):e501-e502

The increasing economic and societal impact of cancer is creating an impetus for change that will likely spread across the health care system in the coming years. As outlined in the May 2015 article from The American Journal of Managed Care, “Transforming Oncology Care: Payment and Delivery Reform for Person-Centered Care,” providers, commercial payers, and the Center for Medicare & Medicaid Innovation are experimenting with a variety of different payment models in oncology, including bundled payments, accountable care organizations, and other financial incentives.

Table

Within the report, the table, “Comparison of Model Approaches,” is useful for tracking the development of cancer payment models. However, based on insights from a recent Network for Excellence in Health Innovation expert roundtable on cancer payment models, we suggest the following additions and recommendations in our ,1-4 including:

  • Allowing for the adoption of new, promising therapies;
  • Promoting the measurement of patient-centered outcomes; and
  • Providing support for personalized medicine.

Author Affiliation: Network for Excellence in Health Innovation, Cambridge, MA.

Source of Funding: Sponsors for the May 27, 2015 roundtable and corresponding research include Anthem, Blue Cross Blue Shield Association, California HealthCare Foundation, Dana Farber Cancer Institute, and Pfizer.

Author Disclosures: Ms Paradis reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design; analysis and interpretation of data; drafting of the manuscript.

Address correspondence to: Rebecca Paradis, MPA, NEHI, Inc, 1 Broadway, 15th Fl, Cambridge, MA 02142. E-mail: rparadis@nehi.net.

REFERENCES

1. Anthem Blue Cross and Blue Shield’s new quality initiative aims to improve cancer outcomes, promote access to evidence-based and cost-effective care [press release]. Mason, OH: Anthem; June 25, 2014. https://www.anthem.com/health-insurance/about-us/pressreleasedetails/OH/2014/1697/anthem-announces-cancer-quality-care-program. Accessed July 10, 2015.

2. WellPoint Cancer Care Quality Program frequently asked questions — California. Anthem Blue Cross Blue Shield website. http://www.anthem.com/ca/provider/f1/s0/t0/pw_e220056.pdf?refer=provider. Updated August 2014. Accessed July 1, 2015.

3. Advancing value in oncology: opportunities and challenges for innovation [video]. Network for Excellence in Health Innovation website. http://www.nehi.net/events/72-advancing-value-in-oncology-opportunities-and-challenges-for-innovation/view. Published June 1, 2015. Accessed July 1, 2015.

4. Horizon Blue Cross Blue Shield of New Jersey announces new collaboration to deliver better care to cancer patients [press release]. Newark, NJ: Blue Cross Blue Shield; September 23, 2014. http://www.bcbs.com/healthcare-news/plans/horizon-bcbsnj-announces-new-collaboration-to-deliver-better-care-to-cancer-patients.html. Accessed July 1, 2015.