Alternative Payment Models

Ishwaria Subbiah, MD, of SCRI Oncology Partners, discusses new findings presented at ASCO 2024. This interview will appear in the annual ASCO recap issue of Evidence-Based Oncology.

While adopting new payment models can come with challenges, there are strategies that can help oncology practices optimize their approaches, said Kathy Oubre, MS, CEO of Pontchartrain Cancer Center.

Coverage from The US Oncology Network Payer Transformation Summit, held September 27-29, 2023, in Atlanta, Georgia.

The single-center study evaluated patients across multiple cancers to understand the utilization, safety, and financial outcomes of bevacizumab-awwb vs reference bevavizumab.

At AHIP 2022, Vanessa Bobb, MD, PhD, FAPA, vice president of Behavioral Health & Medical Integration at CDPHP, moderated a session on real-world study findings showcasing cost and quality benefits of value-based contracting in behavioral health. Bobb discusses findings of the study and how value-based programs can be better leveraged in mental health and substance abuse care.

There are an increasing number of targeted therapies in oncology, but challenges around biomarker testing and treatment selection remain.

Developing alternative payment models for commercial populations in specialties such as oncology is rife with practical challenges. Leading payers and practices share lessons to date.

How Value-based Care Is Changing Radiation Oncology for the Better

The changes come as Tennessee Oncology must now plan for a gap between the Oncology Care Model and a future alternative payment model from CMS.

The Biosimilars Initiative in British Columbia, Canada, mandated patients with certain conditions on the province’s prescription coverage plan to switch from originator etanercept to a biosimilar.

Synthesis of multistakeholder perspectives from a mixed-methods study identifies guiding characteristics for outcomes-based quality measures in future, more patient-centered alternative payment models.

With the ongoing coronavirus disease 2019 pandemic, a rising number of uninsured Americans, and a new Democratic president and Senate majority, 2021 is shaping up to be a dynamic year for health care policy.

A panel at Patient-Centered Oncology Care® 2020 discussed the challenges of a pandemic as oncology practice transformation initiatives continue on.

There is a lot of uncertainty among providers participating in federal alternative payment models (APMs) given the general election and the upcoming Supreme Court case on the Affordable Care Act (ACA).

A discussion of the final Radiation Oncology Model; after this article went to press, CMS announced a delay until July 2021, reflecting concerns of radiation oncologists.

COVID-19 has delayed the transition to Oncology Care First, but the forthcoming model could help.

Bundled payments offer promise as a supplement to existing payment models to promote scaling up of opioid use disorder treatment using buprenorphine.

Benchmarking, accountability, bilateralism, and scalability are the 4 parameters critical to successful alternative payment models in oncology, said Aaron Lyss, MBA, director of strategy and business development at Tennessee Oncology.

CMS Administrator Seema Verma announced the update today in a blog post in Health Affairs.

Networking with other practices, sharing ideas, and getting physicians involved in the process can aid community practices moving to alternative payment models (APMs), said Michael Diaz, MD, president of Community Oncology Alliance.

The Patient-Driven Payment Model addresses perverse incentives in Medicare’s previous payment system for skilled nursing facilities, but it includes new incentives that may be problematic.

Implementing alternative payment models in oncology is a complicated process. The models are not perfect, especially the Centers for Medicare and Medicaid Services’ Oncology Care Model (OCM), although several panelists saw improvements in the proposed successor model, Oncology Care First (OCF).

This review presents a set of evidence-based outcome measures for oncology alternative payment models, drawing on evidence from existing and proposed quality measures.

The November issue of The American Journal of Managed Care® (AJMC®) included studies on a kidney disease intervention, perceptions of alternative financing models, population health screening, and more. Here are 5 findings from research published in the issue.

This study examined how Medicare Advantage plan representatives perceive the alternative financing model Pay for Success and its potential to address members’ social risk factors.

AJMC®TV interviews let you catch up on what’s new and important about changes in healthcare, with insights from key decision makers—from the clinician, to the health plan leader, to the regulator.