Developing Alternative Payment Models That Providers and Commercial Payers Support

David C. Fryefield, MD
Published: Monday, Dec 24, 2018
David C. Fryefield, MD

David C. Fryefield, MD

Patients with cancer in the United States have significantly benefited from steady improvement in treatment outcomes over the past few decades. Data from the National Cancer Institute show a large decline in the cancer death rate, down by 25% since 1990.1 Although some of the improvement is a result of prevention and screening, advances in technology and in chemotherapy and immunotherapy pharmaceuticals have been major driving forces. These advances have come at a significant cost, however. A 2011 study projected that the cost of all cancer care in the United States would rise to 7.7 billion by 2020, up from 4.5 billion in 2010.2

My organization, The US Oncology Network (The Network), has embraced the concept of APMs for oncology services, and we have participated in many discussions with commercial payers. Despite our efforts, we’ve experienced slow adoption of APMs by commercial payers, similar to the experience described by Mechanic and Galvin.

Enter the Oncology Care Model and APMs for Covering Radiation Therapy

Medicare has been actively transitioning provider payments into APMs since 2010.7 In 2016, the Center for Medicare and Medicaid Innovation launched the Oncology Care Model (OCM), a 5-year model to test innovative payment strategies that promote both high-quality and high-value cancer care. Fifteen practices within The Network are participating in the OCM.
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