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Pay-for-Performance Program to Reimburse Oncology Practices for Prescribing Evidence-Based Cancer Drugs


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A pay-for-performance program that offers enhanced reimbursement to oncology practices for prescribing high-quality, evidence-based cancer drugs increased use of these drugs without significantly changing total spending on care, Penn Medicine researchers reported in a study published in the Journal of Clinical Oncology.1 This is reportedly the first study to demonstrate how a national insurer’s voluntary pay-for-performance program can successfully change prescribing patterns among oncologists to deliver higher-quality cancer care.

Justin E. Bekelman, MD

Justin E. Bekelman, MD

“We know that prescribing evidence-based cancer drugs is high-quality care and increases both the length and quality of life for patients with cancer,” said co-lead author Justin E. Bekelman, MD, Director of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center, Professor of Radiation Oncology in the Perelman School of Medicine at the University of Pennsylvania, and Senior Fellow at the Leonard Davis Institute for Health Economics. “And yet, changing prescribing patterns has been and remains a big challenge. Based on what we found here, paying oncology practices to prescribe evidence-based drugs can serve as a valuable tactic to improve the quality of cancer care.”

Study Details

To study the program’s impact on prescriptions and spending, the researchers analyzed patients’ insurance claims data from between 2014 and 2017. They found that a payment of $350 a month per patient to oncology practices, when oncologists prescribed evidence-based cancer drugs, increased prescriptions of those drugs by 5.1%. The study included nearly 1,900 oncologists and more than 25,000 patients with breast, lung, or colorectal cancer across 14 states—62.2% of patients under the program received evidence-based drugs compared with 57.1% of those patients without the program.

In addition to noting an increase in prescriptions, the researchers found that overall spending did not significantly change under the pay-for-performance program. The amount spent on cancer drugs over a 6-month period, however, increased in the pay-for-performance group, going from $48,030 to $51,369, and patient out-of-pocket expenses increased by a small but statistically significant amount, going from $2,217 to $2,470. The researchers also found substantial variability in the prescribing of cancer drug among oncology practices. Over the course of the study, physicians prescribed 402 unique drug regimens, even though only 60 of those regimens were evidence-based drug regimens in the program. Both findings highlight the need for further interventions.

Amol S. Navathe, MD, PhD

Amol S. Navathe, MD, PhD

“The cost of cancer care is too high, just like other areas in health care,” said senior author Amol S. Navathe, MD, PhD, Assistant Professor of Medical Ethics and Health Policy and the Healthcare Transformation Institute, and Senior Fellow at the Leonard Davis Institute for Health Economics at Penn. “This program is a much-needed example of an effective program—one that improved quality of care for patients.” 

DISCLOSURE: HealthCore’s work was funded by Anthem, Inc. For full disclosure information for the study authors, visit ascopubs.org.

REFERENCE

1. Bekelman JE, Gupta A, Fishman E, et al: Association between a national insurer’s pay-for-performance program for oncology and changes in prescribing of evidence-based cancer drugs and spending. J Clin Oncol. October 7, 2020 (early release online).


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