Designing a commercial medical bundle for cancer care: Hawaii Medical Service Association's Cancer Episode Model.

BACKGROUND

Oncology care is expensive and exhibits substantial variation in cost and quality across clinicians and patients. Unlike many conditions with established bundled payment programs, cancer care includes a mix of inpatient and outpatient care that precludes hospital-based designs. In 2018, we worked with Hawaii Medical Service Association (HMSA), the Blue Cross Blue Shield of Hawaii, to design a novel commercial bundle for cancer care, the Cancer Episode Model.

METHODS

Descriptive analysis of HMSA's Cancer Episode Model, including its inclusion criteria, episode definitions, suite of enhanced services, shared savings model, and incentivized quality metrics. We also compare HMSA's Cancer Episode Model to Medicare's Oncology Care Model and three major commercial oncologic alternative payment models offered by Anthem, UnitedHealthcare, and Aetna.

RESULTS

HMSA's Cancer Episode Model builds upon the successes and limitations of Medicare's Oncology Care Model and existing commercial alternative payment models. Compared to Medicare's Oncology Care Model, HMSA's Cancer Episode Model has stricter inclusion criteria, fewer incentivized quality metrics, a higher proportion of regional pricing, a different risk-adjustment model, and first-dollar shared savings. Compared to the majority of existing commercial models, HMSA's Cancer Episode Model includes total cost of care and a different risk-adjustment model.

CONCLUSIONS

Reviewing features of the Cancer Episode Model in comparison to other programs is intended to provide guidance to health plans and health policymakers in the design of programs and policies aimed at improving cancer care value.

LEVEL OF EVIDENCE

Level IV.

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest Dr. Navathe reports grants from Pennsylvania Department of Health, grants from Hawaii Medical Services Association, grants from Anthem Public Policy Institute, grants from Commonwealth Fund, grants from Oscar Health, grants from Cigna Corporation, grants from Robert Wood Johnson Foundation, grants from Donaghue Foundation, personal fees from Navvis Healthcare, personal fees from Agathos, Inc., personal fees from University Health System (Singapore), personal fees from Elsevier Press, personal fees from Navahealth, personal fees from Cleveland Clinic, personal fees from the Medicare Payment Advisory Commission, serving as a board member without compensation for Integrated Services, Inc., and equity from Embedded Healthcare outside the submitted work. Since 2016, Dr. Emanuel reports speaker’s fees from Tanner Healthcare System, Mid-Atlantic Permanente Group, American College of Radiology, Marcus Evans, Loyola University, Oncology Society of New Jersey, Good Shepherd Community Care, Remedy Partners, Medzel, Kaiser Permanente Virtual Medicine, Wallace H Coulter Foundation, Lake Nona Institute, Partners Chicago, Pepperdine University, Huron, American Case Management Association, Philadelphia Chamber of Commerce, Blue Cross Blue Shield Minnesota, UnitedHealth Group, Futures Without Violence, CHOP, Washington State Hospital Association, Association of Academic Health Centers, Blue Cross Blue Shield of Massachusetts, American Academy of Ophthalmology, Lumeris, Roivant Sciences Inc, Medical Specialties Distributors LLC, Vizient University Healthcare System, Center for Neuro-Degenerative Research, Colorado State University, Genentech Oncology Inc, Council of Insurance Agents and Brokers, Grifols Foundation, America’s Health Insurance Plans, Montefiore Physician Leadership Academy, Greenwall Foundation, Medical Home Network, HFMA, Ecumenical Center – UT Health, American Association of Optometry, Associação Nacional de Hospitais Privados, National Alliance of Healthcare Purchaser Coalitions, Optum Labs, Massachusetts Association of Health Plans, District of Columbia Hospital Association, Washington University, Optum, Brown University, America’s Essential Hospitals, National Resident Matching Program, Shore Memorial Health System, Tulane University, and Oregon Health & Science University.Since January 2017, Dr. Emanuel has been a venture partner with Oak HC/FT a firm that invests in health services but not pharmaceuticals or devices. Dr. Emanuel is on the board of two start-ups: Village MD and Oncology AnalyticsDr Volpp reported receiving grants from CVS Health, Humana, Merck, Weight Watchers, and Oscar Health Insurance; receiving personal fees from VAL Health; and that he is part owner of VAL Health.