Assessing Medicare's Approach To Covering New Drugs In Bundled Payments For Oncology
| Autor: | Bruce Pyenson, Pamela M. Pelizzari, Kelsey A. Lang, L. Daniel Muldoon, Joe Vandigo |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Oncology
Male medicine.medical_specialty Insurance Claim Review Antineoplastic Agents Medical Oncology Medicare Reimbursement Mechanisms 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Internal medicine medicine Drug approval Humans 030212 general & internal medicine Patient Care Bundle Drug Approval health care economics and organizations Aged Aged 80 and over business.industry United States Food and Drug Administration Health Policy Bundled payments Reimbursement Mechanism food and beverages Cancer Health Care Costs medicine.disease United States Models Economic 030220 oncology & carcinogenesis business Patient Care Bundles Health reform |
| Zdroj: | Health affairs (Project Hope). 37(5) |
| ISSN: | 1544-5208 |
| Popis: | New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments. One approach, which the Centers for Medicare and Medicaid Services adopted in the Oncology Care Model (OCM), is to partially adjust medical practices' budgets for their use of novel therapies, defined in this case as new oncology drugs or new indications for existing drugs approved after December 31, 2014. In an analysis of the OCM novel therapies adjustment using historical Medicare claims data, we found that the adjustment may provide important financial protection for practices. In a simulation we performed, the adjustment reduced the average loss per treatment episode by $758 (from $807 to $49) for large practices that use novel therapies often. Lessons from the OCM can have implications for other alternative payment models. |
| Databáze: | OpenAIRE |
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