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Will a Payment Change Lead to Better Cancer Care?

You have cancer.

More than a million Americans each year will hear these words. And each year, more than 500,000 Americans will die from cancer.

Oncology care providers seek better ways to serve cancer patients and their families while improving health outcomes and managing costs. Although medical treatments have advanced, some Americans bear a greater cancer burden. African Americans, for example, continue to have higher rates of new cancer cases and higher death rates than other racial/ethnic groups.

“As the payer for half of all cancer services in U.S., the Centers for Medicare & Medicaid Services wants to improve outcomes for all Americans,” said Andrea Hassol, principal associate for U.S. Health. “Too often, cancer patients are challenged by complex but uncoordinated care and high costs, while also facing the uncertainty of a life-threatening diagnosis.”

Abt Global is working with the Centers for Medicare & Medicaid Services (CMS) to determine if a new model that rewards oncologists for coordinating care, and helping patients navigate the health care system, could make a difference.

New Model Emphasizes Care Coordination

CMS recently tapped Abt Global to evaluate its national Oncology Care Model. Abt will determine whether this new model improves cancer care for Medicare patients, including access to care, coordination of care, and patient satisfaction, by changing the way oncologists are paid.

Insurers such as Medicare now pay oncology physician practices based on each service patients receive. CMS’ new model still pays participating practices via fee-for-service, but it also will provide a monthly payment to enhance coordination, patient navigation, 24/7 access, and meet high quality targets. If these strategies can improve patient satisfaction and reduce overall Medicare payments, the oncologists can retain most of those savings as well.

“The oncologist is the quarterback responsible for coordinating all points of care for a patient: surgery, radiation, medication, and care for other health care conditions such as diabetes,” Hassol said, who is also the project director for the evaluation.

The Abt Approach

Abt will rely on its data-driven, mixed methods approach to track progress of the project over five years. The evaluation will compare participating oncology physician practices to other similar non-participating groups to learn whether enhanced services can improve care and reduce costs.

“We will look at a variety of measures: patient satisfaction, quality of care, Medicare spending, and we’ll also look at unanticipated outcomes, both good and bad,” Hassol said.

She explains paying physicians to reduce Medicare spending could unintentionally limit access to, for example, emergency department visits or access to new expensive medicines or experimental treatments. The goal of reducing cost is important, but Hassol cautions, it must not come at the expense of the best evidence-based medical care.

Better Care a Win For All

It will take a while to determine if the model is working. However, Hassol knows it reflects smart thinking about how to improve care at all the junctures where care can break down.

“A cancer diagnosis can be devastating,” Hassol said. "If we can improve the whole experience of having cancer for patients on Medicare that would be a huge win for everyone.”
Read more about Abt’s work in health.

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