Bundled episode payments for cancer care with bonuses for guideline concordance
Pay hospitals a single amount for a whole course of cancer treatment, with extra for following the evidence, rather than paying per visit and per drug, which rewards fragmentation.
The US Oncology Care Model and its successor tested episode-based payment for chemotherapy episodes with quality measures; results on cost were mixed, but process measures improved. A design that ties a larger share of payment to guideline concordance, supportive care access, and avoidance of low-value end-of-life chemotherapy, while adjusting for case mix, could align incentives with coordination. This is a payer experiment, and needs careful attention to unintended effects.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
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not linked directly; found by shared links- IdeaDisclose R&D and manufacturing costs of publicly funded cancer drugs to get coverage
Shares Incentives reward me-too drugs and marginal gains, Prices and value.
- IdeaCap public prices for new cancer drugs to tiers of the ESMO and ASCO value scales
Shares Incentives reward me-too drugs and marginal gains, Prices and value.
- IdeaScreen every patient for financial hardship at diagnosis and connect them to help
Shares Fragmented care and guideline gaps, Prices and value.
- IdeaPay-for-cure contracts: instalment payments for curative therapies contingent on durable remission
Shares Incentives reward me-too drugs and marginal gains, Prices and value.
- IdeaReassess cancer drug prices at three years using real-world outcomes
Shares Incentives reward me-too drugs and marginal gains, Prices and value.
- IdeaA Health Impact Fund pilot that pays for measured health gain instead of price
Shares Incentives reward me-too drugs and marginal gains, Prices and value.
- IdeaPublicly funded dose-reduction trials of expensive approved drugs
Shares Incentives reward me-too drugs and marginal gains, Prices and value.
- IdeaLaunch prices indexed to the ESMO benefit scale, revisited when survival matures
Shares Incentives reward me-too drugs and marginal gains, Prices and value.