What is the problem
Cancer is the fastest growing area of healthcare spending; however, much of that spending does not translate to high-quality patient outcomes. Medicare and commercial insurance programs have begun enacting alternative payment models and other strategies to promote low-cost oncology care. But how have these strategies worked, and how could such programs improve in the future?
What are we doing
We have produced a series of research and thought pieces on the Oncology Care Model -- Medicare's first alternative payment model in oncology. For example, we showed in one article that physicians who participated in CMS's OCM were part of larger and better-resourced practices than the general population, threatening the generalizability of the OCM. Separately, we have also evaluated other value-based care programs, including a utilization management policy from a large national insurer, on evidence-based patient-centric cancer treatment strategies.
Our thought leadership and research on the OCM has led to our selection on a national advisory panel on alternative payment models in oncology care. As part of this advisory panel, we proposed several learning lessons for commercial insurance alternative payment models in oncology care around episode design and care pathways that we expect will shape the next generation of oncology payment models.