Oncology Pathways Within an Alternative Payment Model Helps Lower Cost of Care, JCO Oncology Practice Study Shows

March 24, 2020

A new study in JCO Oncology Practice (JCO OP) shows that using clinical pathways in an oncology-specific alternative payment model (APM) can help reduce the cost of cancer care. The study, “Utilization of Clinical Pathways Can Reduce Drug Spend Within the Oncology Care Model,” supports the American Society of Clinical Oncology’s (ASCO) longstanding view that payers should implement high-quality oncology pathways and test multiple oncology-specific APMs to lower practice spending while continuing to provide high-quality cancer care.

During the study, Cancer Care Specialists of Illinois (CCSI), a community-based oncology private practice, partnered with New Century Health (NCH), a developer of value-based clinical pathways. CCSI, which was participating in the Oncology Care Model (OCM)—a pilot APM developed by the Center for Medicare & Medicaid Innovation—aimed to lower its spending on episodes of care while participating in OCM.

After implementing NCH’s clinical pathway within OCM, between Q1 2017 and Q1 2019, CCSI’s median drug spend increased more slowly than the median drug spend of all OCM participating practices—at 18.6% and 34.4%, respectively. Moreover, during each quarter of the study, CCSI decreased its drug spend by approximately 1.7% relative to the median drug spend of all OCM practices.

In part by addressing its drug spend, CCSI experienced a 5% reduction in total cost of care compared with the median of all OCM practices. Drug spend accounts for more than 50% of episode costs within OCM, and this study demonstrates that a reduction in drug spend is possible within a value-based oncology APM, by using clinical pathways. CCSI also achieved an increase in pathway adherence from 69% to 81% during the study.

These findings support ASCO’s payment reform work, which has long shown the potential for high-quality clinical pathways and oncology-specific APMs to lower costs while maintaining high-quality care for people with cancer. ASCO’s work in this area includes release of the society’s updated Patient-Centered Oncology Payment model (PCOP). ASCO’s model is an oncology-specific APM that uses clinical pathways to better support all of the services needed to treat cancer. ASCO has projected that PCOP could yield significant cost savings—up to 8%—across the healthcare system.

Read the full study in JCO OP.

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