Oncology value based payment models: Where are the savings opportunities?
Autor: | Kristen K. McNiff Landrum, Jennifer Malin, Jon Maguire, Tracy E. Spinks, Era Kim Oh |
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Rok vydání: | 2021 |
Předmět: | |
Zdroj: | Journal of Clinical Oncology. 39:69-69 |
ISSN: | 1527-7755 0732-183X |
DOI: | 10.1200/jco.2020.39.28_suppl.69 |
Popis: | 69 Background: Oncology practices are increasingly participating in value-based payment (VBP) arrangements; however, there is limited information on where practices have the greatest impact on reducing medical costs. Methods: United Healthcare (UHC) conducted a pilot to evaluate a VBP consisting of an episode fee, eliminating drug margin, and shared savings. The pilot was limited to members with breast, lung or colon cancer enrolled in UHC’s commercial plans. We compared total medical cost (TMC) per 120-day episode calculated from paid claims amounts for the pilot practices with a concurrent national cohort for the performance period (9/2015-9/2019) and a baseline period (1/2013-3/2015) using a difference-in-differences technique with a generalized linear regression model, adjusting for age, gender, cancer type and stage (adjuvant vs. metastatic), comorbidities, cancer surgery, radiation therapy, novel therapy, duration of therapy, and region. We categorized claims into 6 categories and estimated the impact of the VBP on costs: chemotherapy/drugs, radiation therapy, cancer surgery, cancer diagnostics, other cancer-related and other non-cancer related. In addition, we evaluated the difference in acute inpatient admission rates. Results: Patient treated in the pilot practices contributed 2,647 episodes of a total of 73,352 episode during the performance period, weighted equally between adjuvant and metastatic disease (Table). The adjusted TMC per 120-day episode was $36,434 for the national cohort and $37,215 for the participating clinics at baseline and $50,773 and $41,416, respectively during the performance period, resulting in an average decrease in TMC of $9,687 or a 20% reduction; although this varied significantly by stage and cancer type. The relative decrease in medical costs by category ranged from 13% for chemotherapy/drugs to 33% for cancer surgery and an increase in costs associated with cancer diagnostics of 7%; however, chemotherapy/drug were still associated with the largest absolute decrease in costs ($2,941). Practices participating in the pilot had a 24.7% decrease in the number of acute inpatient admissions and 12.6% decrease in the number of inpatient admission days; however, this did not reach statistical significance. Conclusions: Overall, practices participating in a VBP pilot with a commercial health plan decreased TMC per episode by 20% with savings across all cost categories except for cancer diagnostics.[Table: see text] |
Databáze: | OpenAIRE |
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