The impact of an oncology-specific shared savings agreement.

Abstract

1536 Background: In response to rising healthcare costs, several innovative payment strategies have emerged to improve the value and efficiency of healthcare spending. One of these strategies is a shift from volume-based to value-based care (VBC), resulting in the introduction of alternative payment models, innovative provider contracting and new value frameworks. The purpose of this study is to evaluate the impact of a VBC arrangement on total cost of care for chemotherapy patients, specifically cancer-related drug costs, daily hospital inpatient admissions and emergency room visits. Methods: This is a cohort study of chemotherapy patients, in a single state, enrolled in a large national insurer from January 18, 2021, to September 30, 2021. Oncology patients were divided into two groups; the study group consisted of chemotherapy patients receiving care in a VBC arrangement; the control group consisted of chemotherapy patients receiving care at oncology practices not engaged with the insurer in a VBC agreement. The following levers were employed to improve value: digital symptom tracking, biosimilar or lower-cost drug options and NCCN regimen concordance. We defined cancer-related drug costs as the sum of allowed costs paid for medical and pharmacy claims during the study period. Additionally, we averaged the cost per hospital inpatient day and emergency room visit and compared these by group. Results: This study included 1,574 patients, 733 patients in the study group and 841 in the control group. A reduction of 5.1% (a difference of $441) in cancer-related drug costs per member per treatment month (PMPTM) was observed among patients in the study group. Patients in the study group reported 27.8% fewer inpatient days resulting in a savings of $194 PMPTM. Similarly, patients in the study group reported 70.0% fewer emergency room visits resulting in a savings of $59 PMPTM. Conclusions: In this study, chemotherapy patients participating in a shared savings VBC spent less on cancer-related drug costs, hospital inpatient days and emergency room visits through three value levers. Further studies are needed to assess if these results are similar all types of healthcare coverage and to what degree additional value levers further reduce costs. Additionally, the long-term health outcomes of these patients should be assessed.