Value-Based Oncology Payment Models Lack Needed Clinical Granularity, Study Suggests

Bundling cancer treatment in ways that better reflect resource utilization for an appropriate standard of care would improve value-based payment models in oncology, such as Medicare’s Oncology Care Model, according to an abstract presented at the 2021 ASCO Annual Meeting. 

“Aggregating different subtypes of cancers into bundles is an important methodology in oncology payment reform as an alternative to fee for service,” wrote authors from Tuple Health in Washington, DC, and Florida Cancer Specialists North/Sarah Cannon Research Institute, Gainesville, FL. “However, expected resource utilization can vary significantly across cancer subtypes.” 

The study focused on chronic leukemia subtypes of chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL).  

When the chronic leukemia subtypes were modeled using the aggregate Oncology Care Model bundle, CML and CLL had significantly different cost distributions and different patterns of expected resource utilization, researchers found. 

On average, CLL episodes were 13.7% over target, while CML episodes were 6.1% under target, according to the study. Average CLL episodes cost $52.2K compared with an average target of $47.6K, and 54% of CLL episodes cost more than the target. Meanwhile, average CML episodes costs $45.2K compared with an average target of $50.3K, and 43% of CML episodes exceeded the target. 

“Insufficient clinical granularity in bundle construction can lead to provider performance being influenced by the distribution of patient subtypes at the practice,” researchers advised. “This can lead to inappropriate shifts of risk from payers to providers in value-based models.” 

Reference: 

Yue A, Connor N, Gordon LN, Tran L, Chaudhry BI. Modeling Medicare’s Oncology Care Model bundles at more clinically granular levels: evaluating the impact on provider performance. Abstract presented at 2021 ASCO Annual Meeting; June 4-8, 2021.