Table 2.

Summary of alternative payment and care delivery models in cancer care

First Author	Intervention | Payer type	Study Design | Setting | Cancer studied	Peer-review	Patients in intervention | control	Brief Description	Outcomes Measured	Results	Impact on Value
Bundled Payments
Bandell14	BCBS of Florida Radical Prostatectomy Bundle | Private	NA | Community | Prostate	No	NA	BCBS partnered with Mobile Surgery International to develop prostatectomy bundle for early stage prostate cancer.	NA	NA	NA
Butcher15	CTCA Bundle | Private	NA | Community | prostate, breast, lung and colorectal	No	NA	CTCA developed a bundle for the diagnosis and care planning of 4 cancer types. Episodes included medical, surgical and radiation oncologist consults, imaging and pathology services, and other consult services.	NA	NA	NA
Castelluci16	BCBS of CA Breast Cancer Bundle | Private	NA | Community | Breast	No	NA	BCBS partnered with Valley Radiotherapy Associated Medical Group to develop a radiation bundle for early stage breast cancer.	NA	NA	NA
Feeley17	MD Anderson Head and Neck Bundle | Private	NA | NCI designated cancer center | Head and neck	No	NA	UHC partnered with MD Anderson to develop a bundle covering comprehensive services to manage head and neck cancer. Episode length of 12 months.	NA	NA	NA
Loy18	EBRT Bundle | Private	Pre-post with concurrent control | Community | Breast, Lung, Skin, Prostate cancer, and Bone metastases	Yes	515 | 433	Humana partnered with 21st Century Oncology practice to form a bundle for EBRT. Episode length of 90 days.	Guideline concordance, under- and over- treatment.	No change in guideline concordant care for breast, lung, and skin cancers. Improvements in guideline care for bone metastases and prostate cancer. Under-treatment declined from 4% to 0%. Over-treatment was unchanged.	Neutral
Newcomer19	UHC Bundle Pilot | Private	Pre-post with concurrent control | Community | Breast, lung, colon	Yes	810 | NA	UHC partnered with 5 medical oncology groups. Episodes included hospital care, hospice, case management, and eliminated % based chemotherapy drug incentive. Episodes length of 4–12 months.	Hospitalizations, therapeutic radiology use, chemotherapy drug cost, net savings.	Decreased hospitalization and therapeutic radiology use. Increase in chemotherapy drug costs. Net savings of $33.36 million.	Increased
Accountable Care Organizations
Butcher20	Aetna Cancer-Specific ACO | Private	Pre-post for costs, Cohort study for utilization | Community | Breast, Lung, Colon	No	184 | NA	Aetna partnered with Texas Oncology to form ACO pilot.	ER visits, hospitalizations, LOS, costs.	40% fewer emergency room visits. 16.5% fewer hospitalizations. 36% fewer inpatient days. 10% lower 1-year costs, 12% lower 2-year costs.	Increased
Colla21	PGPD Project | Medicare	Pre-post with concurrent control | Community | All	Yes	104,766 | 727,969	Medicare claims analysis of cancer outcomes after PGPD.	Hospitalizations, costs.	PGPD enrollment was associated with a $721 (3.9%) reduction in annual Medicare spend per patient, which was driven exclusively by decreased inpatient stays.	Increased
Herrel22	MSSP ACO Analysis | Medicare	Pre-post with concurrent control | Mixed settings | Colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer	Yes	19,439 | 365,080	Medicare claims analysis of surgical cancer outcomes after MSSP enrollment.	Mortality, readmissions, complications, LOS.	ACO enrollment had no effect on 30-day mortality, readmissions, complications, or LOS.	Neutral
Mehr23	BCBS Cancer- Specific ACOs | Private	NA | NCI designated cancer center, Community | All	Yes	NA	BCBS partnered with Moffit Cancer Center, Baptist Health South Florida and Advanced Medical Specialties, to form a cancer ACO.	NA	NA	NA
Patient Centered Medical Homes
Bosserman24	Wilshire Oncology Pilot| Private	NA | Community | All	Yes	NA	Wilshire Oncology partnered with CA Anthem Blue Cross WellPoint to form an oncology medical home pilot.	NA	NA	NA
Butcher25	COA Initiative | Mixed	NA | Community | All	No	NA	COA approached CMMI and private payers about a medical home demonstration project.	NA	NA	NA
Goyal27	North Carolina Medicaid PCMH | Medicaid	Concurrent comparator | Mixed settings | Breast	Yes	308 | 262	Medicaid claims analyses of breast cancer patients enrolled in the Community Care of North Carolina PCMH.	Outpatient or ER visits for chemo-related adverse event.	PMCH enrollment was not associated with differences in outpatient or ER visits for chemo-related adverse events.	Decreased
Kohler26		Concurrent comparator | Mixed settings | Breast	Yes	3,857 person-months | 5,550 person-months	Medicaid claims analyses of breast cancer patients enrolled in the Community Care of North Carolina PCMH.	Outpatient service use, ER visits, hospitalizations, costs.	PCMH enrollment was associated with higher monthly outpatient service utilization, no effect on ER visits or hospitalizations, and a $429 per month increase in expenditures for the first 15 months. This effect was not significant at 24–36 months.
Kuntz28	Michigan Oncology Medical Home | Private	Pre-Post | Community | All	Yes	85 | 485	4 oncology practices partnered with Priority Health to develop a model that reimbursed for chemo and treatment planning and advanced care planning consultation with a shared savings opportunity.	ER visits, hospitalizations, costs.	Reduced ER visits by 47% and hospitalizations by 68%. Estimated savings per patient was $550.	Increased
Reinke29	CareFirst | Private	Pre-post with concurrent control | NA | NA	No	8 pilot practices | 7 control practices	A Maryland/Washington BCBS plan that created a voluntary medical home model based on its pathway program.	Office visits, # cycles per patient, % receiving chemo, % receiving all-generic chemotherapy.	No effect on office visits, average number of cycles given per patient, proportion of patients receiving chemotherapy, and proportion of patients receiving all-generic chemotherapy.	Neutral
Shah30	National PCMH | NA	Concurrent comparator | Mixed settings | All	No*	NA | NA	Survey analysis of PCMH access and outcomes for cancer survivors.	ER visits, prescribing behavior, outpatient visits, hospitalizations, costs.	Reduced ER visits and prescription medications for cancer survivors with access to PCMH. No effect on outpatient visits, hospitalizations, or total costs.	Neutral
Sprandio12	CMOH | Private	Pre-post | Community | All	Yes	NA|NA	CMOH, a nine-Oncologist physician practice, formed the first oncology medical home.	ER visits, hospitalizations, LOS, costs.	Reduced ER visits by 68%, hospitalizations by 51%, and LOS by 21%. Approximate aggregate savings of $1 million per physician per year to insurers.	Increased
Tirodkar31	Patient-centered oncology practice standards pilot | NA	NA | Mixed | NA	Yes	NA	Pilot of incorporating patient-centered oncology practice standards at 5 oncology practices. Standards included improved communication, care coordination, and performance measurement.	NA	NA	NA
Waters32	COME HOME | Medicare	Pre-Post | Community | Breast, Lung, or Colon	Yes	16,353 | NA	Received a grant from CMMI to replicate and scale a patient centered cost-reduction program across 7 oncology practices.	ER visits, hospitalizations, patient satisfaction.	Participating sites reduced ER visits by 23% and hospitalizations by 28%. Patient satisfaction rates remained >90%.	Increased
Other Alternative Payment or Care Delivery Interventions
Kwon33	Glioma IPU | NA	NA | Community | Glioma, metastatic cancer to the brain, meningioma	No*	NA	Virtual IPU including neurosurgery, neuro oncology, radiation oncology, neuroradiology, and neuropathology.	NA	NA	NA
Sharma34	The Diabetes Oncology Program | NA	Pre-post | Community | All	No×	98 | 383	Integrated care model including oncologist, endocrinologist, primary care physician, nursing staff, and diabetes educator.	ER visits, hospitalizations.	Reduced aggregate ER visits, observation stays, and hospitalizations by 3.4% in cancer patients with diabetes.	Increased
Timmins35	Gynecologic Oncology capitated model | Private	NA | Community | Gynecologic cancers	No*	NA	Private practice group partnered with health plan to create a capitated annual payment per patient (excluding drug costs).	NA	NA	NA

Abbreviations: BCBS = Blue Cross Blue Shield; NA = Not available; CTCA = Cancer Treatment Centers of America; CA = California; NCI = National Cancer Institute; UHC = United Healthcare; EBRT = External beam radiation; ER = Emergency room; LOS = length of stay; PGPD = Physician Group Practice Demonstration; MSSP = Medicare Shared Savings Program; COA = Community Oncology Alliance; CMMI = Center for Medicare & Medicaid Innovation; CMOH = Consultants in Medical Oncology and Hematology; COME HOME = Community Oncology Medical Home; IPU = Integrated Practice Unit.

^*Abstract Only

^×Graduate School Dissertation