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Application of Payment Reform Models in Oncology

Panelists:Michael Kolodziej, MD, Aetna; Andrew L. Pecora, MD, FACP, CPE, John Theurer Cancer Center; Jeffery C. Ward, MD, Swedish Cancer Institute
Published: Monday, Oct 19, 2015


ASCO has proposed new payment approaches that have some flexibility, notes Jeffrey C. Ward, MD. One model, he explains, is based on a fee-for-service system, but adds patient management fees and accountability for lowering the cost of care. It has not yet been determined whether unnecessary utilization is reduced with this model.

A variation on this model incorporates a monthly bundled payment that allows for flexibility in how the care is provided. This allows practices to innovate and add other care providers to the team, such as palliative care clinicians or nurse practitioners. It also allows them to practice at the top of their licenses, says Ward.

The final model is based on an all-inclusive bundle, which can include medications or exclude them. Many practices will never be able to manage this level of risk, states Ward. Although the Centers for Medicare & Medicaid Services’s Oncology Care Model may have benefits, adds Ward, it is important to test other models as well.
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ASCO has proposed new payment approaches that have some flexibility, notes Jeffrey C. Ward, MD. One model, he explains, is based on a fee-for-service system, but adds patient management fees and accountability for lowering the cost of care. It has not yet been determined whether unnecessary utilization is reduced with this model.

A variation on this model incorporates a monthly bundled payment that allows for flexibility in how the care is provided. This allows practices to innovate and add other care providers to the team, such as palliative care clinicians or nurse practitioners. It also allows them to practice at the top of their licenses, says Ward.

The final model is based on an all-inclusive bundle, which can include medications or exclude them. Many practices will never be able to manage this level of risk, states Ward. Although the Centers for Medicare & Medicaid Services’s Oncology Care Model may have benefits, adds Ward, it is important to test other models as well.
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