Biomaterial Database

Oncology payment reform to achieve real health care reform. 2015

Mark B McClellan, and Andrea I Thoumi

The Brookings Institution, Washington, DC mmcclellan@brookings.edu.

Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.

UI	MeSH Term	Description	Entries
D008495	Medical Oncology	A subspecialty of internal medicine concerned with the study of neoplasms.	Oncology, Medical,Clinical Oncology,Oncology, Clinical
D011050	Policy Making	The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.	Analysis, Policy,Policy Analysis,Policy Development,Analyses, Policy,Development, Policy,Developments, Policy,Making, Policy,Policy Analyses,Policy Developments
D012051	Reimbursement Mechanisms	Processes or methods of reimbursement for services rendered or equipment.	Mechanism, Reimbursement,Mechanisms, Reimbursement,Reimbursement Mechanism
D003362	Cost-Benefit Analysis	A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. In contrast a cost effectiveness in general compares cost with qualitative outcomes.	Cost and Benefit,Cost-Benefit Data,Benefits and Costs,Cost Benefit,Cost Benefit Analysis,Cost-Utility Analysis,Costs and Benefits,Economic Evaluation,Marginal Analysis,Analyses, Cost Benefit,Analysis, Cost Benefit,Analysis, Cost-Benefit,Analysis, Cost-Utility,Analysis, Marginal,Benefit and Cost,Cost Benefit Analyses,Cost Benefit Data,Cost Utility Analysis,Cost-Benefit Analyses,Cost-Utility Analyses,Data, Cost-Benefit,Economic Evaluations,Evaluation, Economic,Marginal Analyses
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D017046	Cost Savings	Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.	Cost Saving,Saving, Cost,Savings, Cost
D058996	Quality Improvement	The attainment or process of attaining a new level of performance or quality.	Improvement, Quality,Improvements, Quality,Quality Improvements
D018166	Health Care Reform	Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.	Healthcare Reform,Health Care Reforms,Healthcare Reforms,Reform, Health Care,Reform, Healthcare,Reforms, Health Care,Reforms, Healthcare
D018588	Fee-for-Service Plans	Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)	Fee-for-Service, Medical,Reimbursement, Fee-for-Service,Fee for Service,Fees for Service,Fee for Service Plans,Fee for Service, Medical,Fee for Services,Fee-for-Service Plan,Fee-for-Service Reimbursement,Fee-for-Service Reimbursements,Fee-for-Services, Medical,Fees for Services,Medical Fee-for-Service,Medical Fee-for-Services,Plan, Fee-for-Service,Plans, Fee-for-Service,Reimbursement, Fee for Service,Reimbursements, Fee-for-Service,Service, Fee for,Service, Fees for,Services, Fee for,Services, Fees for
D018854	Managed Competition	A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)	Accountable Health Plans,Competition, Managed,Health Plans, Accountable,Accountable Health Plan,Health Plan, Accountable,Plan, Accountable Health,Plans, Accountable Health