Quality Initiatives, Health Care Reimbursement Crucial to APM Long-Term Success


A recent literature review analyzed the alternative payment models used in the real world and how they have affected the quality of oncology care.

The review was published in the American Journal of Managed Care (March 2018;24[3]:e93-e98).

Variations in cancer health care delivery across different sites of care may lead to diverse outcomes. Among the alternative payment models (APMs) being implemented in the real-world setting include accountable care organizations, bundled payments, clinical pathways, and patient-centered medical homes.

Lonnie Wen, RPh, PhD, Bayer HealthCare Pharmaceuticals (Whippany, NJ), and colleagues conducted a literature review to describe how leading oncology care organizations are involved with linking quality improvement initiatives and payment reform. Researchers sought to provide an overview of real-world applications of APMs in oncology and how such models have complemented quality improvement with payment reform.

Researchers found that the driving force behind implementing APMs linked with quality can be attributed to the initiatives of several leading national organizations: the National Academy of Medicine, the American Society of Clinical Oncology, the National Committee for Quality Assurance, the US Department of Health and Human Services, and the Centers for Medicare and Medicaid Services. These organizations are involved in developing and endorsing quality measures, developing guidelines and care improvement models, accrediting and certifying providers and health plans, and utilizing data to monitor outcomes for public reporting, researchers noted.


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Additionally, investigators referenced that while real-world evidence of APMs is sparse and lacking in many important reported health outcomes, the data show that progress is occurring toward improving the quality of oncology care in the United States while simultaneously reducing costs.

As quality linked to payment reform has gained momentum and is being mandated at the national level, it is imperative to rapidly implement more real-world applications of quality initiatives linked to oncology-specific APMs and the educational framework needed to support them,” Dr Wen and colleagues concluded. “The effective pairing of quality initiatives with the healthcare reimbursement structure will likely be key to the long-term success of such APMs in cancer care.”—Zachary Bessette