Optimal Oncology Alternative Payment Models, April 2021
As the Biden administration carves out its approach to healthcare policy, some healthcare thought leaders are reflecting on the successes and failures of recent experiments in payment reform. Voluntary alternative payment models (APMs) in a range of specialties have proliferated in recent years with mixed outcomes to date, including limited success in generating net savings. This has prompted some influential bodies, such as the Medicare Payment Advisory Commission, to consider recommending that the Center for Medicare and Medicaid Innovation (CMMI) streamline its portfolio of APMs. In oncology specifically, CMMI’s Oncology Care Model (OCM) has undoubtedly yielded some impact, but it too has resulted in net losses for the Medicare program, and detailed plans for a successor program have yet to be announced.
As Medicare’s near-term plans for oncology payment reform remain uncertain, some stakeholders are looking to the commercial sector for insights to inform oncology APM design and good practices. Yet early lessons from commercial ventures in this space echo conclusions drawn from the OCM: challenges in design and implementation abound, and meaningful cost savings may be elusive in the short term.
Against this backdrop, participants of the oncology APMs advisory council reconvened in March 2021 for a pulse check on stakeholders’ outlook for APMs in this specialty. While some participants were cautiously optimistic that APMs remain a viable tool to improve healthcare quality and sustainability, others reiterated concerns that APMs have yielded limited impact and questioned whether they can be effectively scaled. The council also met to refine lessons learned from commerical APMs to incorporate into a planned article by a subgroup of council participants, one of the next steps that the council supported during its October 2020 meeting.
This Summary of Themes provides a brief overview of the meeting.