Oncology Care Model Drives Shift towards Value-Based Cancer Treatment, Expert Says
WASHINGTON, D.C. – The Oncology Care Model (OCM) is fostering a greater emphasis on the connection between clinical outcomes and the total cost of cancer care, leading to increased utilization of biosimilars and a focus on lower-cost, high-quality treatment options, according to Sophia Humphreys, PharmD, MHA, BCBBS. Humphreys shared these insights during a recent panel discussion, “the Delicate Dance: When Payment Models Fall Short of Innovation,” alongside Aaron Lyss, MBA; Stuart Staggs, MSIE; David Johnson, MD, MPH; and Lalan Wilfong, MD.
Launched several years ago, the OCM has prompted a reevaluation of cancer care payment structures, moving beyond traditional fee-for-service models. While a recent CMS report indicated that overall total cost of care did not decrease for participating clinics, meaningful reductions were observed in supportive care costs. This shift suggests a growing adoption of more affordable alternatives,such as biosimilars,without compromising patient care.
“Ever since the launch of the Oncology Care Model,it has brought a lot of emphasis on the link between clinical outcomes and the total cost of care,” Humphreys stated. “The cost of supportive care for almost all [OCM participants] started to reduce, which means that we are starting to use more biosimilars, and we are starting to really look at lower-cost, higher-quality, or equal-quality products that can treat our patients.”
The evolving landscape of cancer treatment, with the introduction of innovative therapies like bispecifics and [chimeric antigen receptor] T-cell therapy, is also driving the development of new payment models, including bundled payments. Humphreys noted that OCM has “opened the doors and has brought more focus on managed care.”
Beyond OCM, innovative payment arrangements are emerging to address the high cost of novel cancer drugs. These include payment guarantees – where manufacturers reimburse payments if patients don’t meet pre-defined criteria – and contracts based on “extended period response,” tying reimbursement to sustained clinical outcomes,such as relapse-free survival for a specified duration. Humphreys also cited instances of manufacturers offering a free second dose of medication if the initial treatment proves ineffective.
“Also, there’s something called extended period response,” Humphreys explained. “Say, such as, I have a patient with [refractory multiple myeloma] and I have a contract for a specific product, with predetermined clinical outcomes for how long the patient would have the same outcome, for example, if the patient would not relapse for 12 months, 18 months, or longer. I’ve seen that type of contract as well.”
