Report Identifies Considerations for Alternative Payment Models for Cancer Care


​PHILADELPHIA — A roundtable convened by the Turning the Tide Against Cancer initiative, composed of a multidisciplinary group of stakeholders, put forth five policy considerations that are critical to ensuring the delivery of high-quality oncology care while supporting innovation. The report was published today in Clinical Cancer Research, a journal of the American Association for Cancer Research (AACR).

The Turning the Tide Against Cancer initiative is a collaboration between the AACR, the Personalized Medicine Coalition, and Feinstein Kean Healthcare to work with members of the cancer community to identify policies that sustain medical innovation while addressing the issue of rising health care costs.

The report is being published in conjunction with a science policy session titled, "The Impact of the Affordable Care Act (ACA) on Cancer Research, Care, and Prevention," held Sunday, April 17, at 11a.m. CT, at the AACR Annual Meeting 2016, in New Orleans, Louisiana.

"Cancer care has featured prominently in the national conversation about value-based health care, which is not surprising given the health and economic burdens of cancer in the United States, as well as the unique needs of cancer patients," the authors wrote in the study, titled "The impact of alternative payment models on oncology innovation and patient care."

Alternative payment models (APMs) have become more common amid pressures to curb health care costs, the study authors wrote. APMs exist in several forms, including accountable care organizations, episode-based payment models, and oncology patient-centered medical homes.

"Stimulated by the Affordable Care Act, Medicare has called for rapid implementation of APMs, encouraging value-based care and cost containment in oncology practices," said Gilbert Omenn, MD, PhD, director, Center for Computational Medicine and Bioinformatics, University of Michigan, chair of the AACR Health Policy Committee, and co-author of the study. "If structured appropriately and updated with new knowledge, these APMs can incorporate validated new therapies, encourage shared decision-making between health care providers and patients, and improve the outcomes of oncology care. Value-based strategies need to capture the advances from scientific innovation and clinical trials, and support evidence-based, personalized, patient-centered approaches."

The other co-authors of the study are: Amy Miller, PhD, executive vice president, Personalized Medicine Coalition, and Marcia Kean, MBA, chairman, Feinstein Kean Healthcare.

In July 2015, the Turning the Tide Against Cancer initiative convened a roundtable to discuss the effects of APMs on oncology innovation and patient care. The participants included physicians, researchers, advocates, representatives of insurers and pharmaceutical companies, and policymakers. The group identified five issues for the future design and implementation of APMs:

  • APMs should keep pace with rapidly emerging science by incentivizing the adoption of innovative medicines and technologies that have the potential to improve patient outcomes and make health care more efficient.
  • APMs should include mechanisms to encourage patient participation as appropriate in clinical trials as well as ongoing post-market clinical research.
  • Clinical pathways should be transparent and evidence-based, and updated regularly to reflect current scientific evidence and clinical advances within the overall continuum of care.
  • When providers and patients are making treatment decisions, patients should be given a clear, comprehensive picture of their treatment options, including cost information that is tailored to the specific patient's insurance coverage and treatment plan.
  • APMs should require that clinical data be aggregated and integrated into providers' workflows via electronic health records in order to support learning health care systems. Providers should have access to data that will support their shared decision-making with patients. Similarly, patients should have access to research results collected through a learning health care system.

These recommendations will be discussed in greater detail at the Annual Meeting 2016 session.

In the future, the authors wrote, APMs should continue delivering value-based care to patients, making health care more accessible and affordable while continuing to use emerging research to provide the most innovative care.

"Ultimately, APMs can be a powerful means of driving innovation in treatment and care delivery, facilitating research and promoting access for patients with cancer to proven, individualized life-changing treatments," the authors wrote. "APMs may generate larger numbers of patients with multidimensional data leading to better-informed assessments of the real-world effectiveness of candidate therapies and modes of care delivery."