• Rhonda Greenapple.
• Ms Greenapple is President and Founder, Reimbursement Intelligence, Madison, NJ.
• Am Health Drug Benefits. 2013 Jul 1;6(5):249-56.

BackgroundOncology practices are seeking to adapt to new care delivery models, including accountable care organizations (ACOs), patient-centered medical homes (PCMHs) in oncology, and oncology pathways, as well as new payment models, such as bundled payments or pay-for-performance contracts.ObjectiveOur survey sought to determine which payment models and care delivery models payers view as the most viable and the most potentially impactful in managing and reducing the cost of cancer care.MethodsWe conducted an online national survey of 49 payers, including 19 medical directors and 30 pharmacy directors, representing more than 100 million covered lives within national and regional plans, using a validated instrument comprised of approximately 120 questions. The survey was administered using the SurveyGizmo website. It was initiated on July 10, 2012, and completed on July 25, 2012. The survey included open- and closed-ended questions and probed payers about models of care that they, in collaboration with providers, are implementing or supporting to improve the quality of cancer care and to reduce the associated costs.ResultsPayers are rapidly moving to implement new reimbursement models to support new care delivery models, including ACOs and PCMHs. Based on the results of this survey, a minority of payers are experimenting with new oncology payment models, but most payers are evaluating various models, including bundled payments, capitation, shared savings, and pay for performance. Of the payers in this survey, 39% have already implemented oncology pathways, and 59% who have not already done so are planning to implement pathways in 2 years. Input from local oncology experts is an important resource for pathway development, and a substantial majority (95%) of payers will use pathways to address earlier initiation of palliative care discussions where appropriate.ConclusionPayers anticipate that there will be a rapid expansion of the use of innovative approaches to oncology cost management over the next 2 years. As payers and their network providers gain more experience in collaborative care delivery, it is expected that demonstration of cost-savings will become more robust and convincing, and a variety of approaches will become more widely adopted.

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