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. 2022 Mar;28(3):98-100.
doi: 10.37765/ajmc.2022.88835.

Oncology alternative payment models: lessons from commercial insurance

Elizabeth Shaughnessy  1 , David C Johnson, Aaron J Lyss, Ravi B Parikh, Steven R Peskin, Blase N Polite, Julie A Royalty, Bhuvana Sagar, Erin Smith, Lindee Goh
Affiliations

Oncology alternative payment models: lessons from commercial insurance

Elizabeth Shaughnessy et al. Am J Manag Care. 2022 Mar.

Abstract

Many payers and clinicians are committed to advancing value-based care through the establishment of alternative payment models (APMs) that incentivize practices and clinicians to improve quality and reduce cost. A multistakeholder working group has observed that in specialty fields such as oncology, despite many attempts to design and implement APM pilots for commercial and Medicare Advantage populations, practical challenges and small numbers of episodes and patients present headwinds to viability and scalability. Despite this, some payers report emerging good practices and are optimistic about APMs. Careful and realistic consideration of the specific goals of a proposed model is warranted, as is close examination of the feasibility of transferring risk.

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Conflict of interest statement

Author Disclosures: Ms Shaughnessy and Dr Goh are employed by Tapestry Networks, which was paid by Amgen to run the council from which this work originated. Mr Lyss has received honoraria from Genentech, EMD Serono, Heron, Avalere, and The American Journal of Managed Care®, all outside of this work. Dr Parikh has received consulting fees from GNS Healthcare, Onc.AI, Cancer Study Group, and NanOlogy; grants from Humana, National Institutes of Health, Conquer Cancer, and Department of Veterans Affairs; and honoraria from Flatiron and Medscape; and owns stock in GNS Healthcare and Onc.AI, all outside of this work. Dr Polite has received speaking and consulting fees from Natera, research fees from Merck, and consulting fees from Genzyme, each not directly related to this article. Ms Royalty was employed by Humana at the time this manuscript was finalized and took part in an unpaid collaboration with the American Society of Clinical Oncology and Community Oncology Alliance, all outside of this work. Dr Sagar is employed by and owns stock in Cigna Healthcare/Evernorth. Ms Smith was employed by Anthem at the time this manuscript was finalized. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

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