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Will New Medicare Payment Model Hurt Individualized Cancer Care?

by Amanda Conschafter, blog editor

A new oncology payment model rewards “value of care, not volume” says the Centers for Medicare and Medicaid Services. Designed to enhance care coordination, the model encourages patient-centered oncology. But some worry that it’s not all good news for cancer patients. By incentivizing health care providers to reduce costs – and not accounting for the use of breakthrough new medicines – the model could limit patients’ individualized care.

Spurred by the goals of the Affordable Care Act, the Oncology Care Model is among several innovative payment models to come from the Medicare and Medicaid Innovation Center. The model makes good on Health and Human Services Secretary Sylvia Burwell’s goal of tying 50 percent of Medicare payment models to value by 2018. Its improvements for patients include:

  • Patient navigators
  • 24/7 access to health care providers
  • Enhanced care plans.

Yet in its efforts to use health care dollars more wisely, the program incentivizes cost savings for some variable and potentially personalized aspects of cancer care. This aspect of the program could encourage health care providers to reduce patient options based on cost alone.

Also problematic, the model doesn’t address the use of new treatments. These might be higher cost but could offer important options for cancer patients. If the payment model’s system of target costs and related incentives doesn’t take these into account, however, physicians may avoid prescribing new therapies – despite their potential for patients.

Several organizations have expressed concerns. The American Society of Clinical Oncology offered an alternative payment model suggestion. And the pharmaceutical trade association said that the Medicare model “falls short” by imposing patient access barriers to cancer therapies covered by Medicare Part D.

Medicare looks to implement the program in the spring of 2016. Meantime, patients, advocates and stakeholders are welcome to submit comments about the effect the model might have on cancer patients.

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The Alliance for Patient Access is a national network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care.
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