A national pay-for-performance program offered enhanced reimbursements to oncology practices for prescribing high-quality, evidence-based cancer drugs, and successfully increased prescriptions without significantly changing the total spending on care, according to a study published in the Journal of Clinical Oncology. This is the first study to demonstrate how a national insurer’s voluntary pay-for-performance program could successfully change prescribing patterns among oncologists, the study authors noted.

Investigators analyzed insurance claims data for patients with cancer between 2014 and 2017, which showed that a payment of $350 per month per patient to oncology practices when oncologists prescribed evidence-based cancer drugs increased prescriptions of those drugs by 5.1 percentage points. Nearly 1900 oncologists were included in the study as were more than 25,000 patients with breast, lung, or colorectal cancers across 14 states. Specifically, 62.2% of patients under the program received evidence-based drugs compared with 57.1% of patients not in the program.

“We know that prescribing evidence-based cancer drugs is high-quality care and increases both the length and quality of life for patients with cancer,” said co-lead author Justin E. Bekelman, MD, in a press release. “And yet, changing prescribing patterns has been and remains a big challenge. Based on what we found here, paying oncology practices to prescribe evidence-based drugs can serve as a valuable tactic to improve the quality of cancer care.”

Evidence-based cancer regimens have been shown to result in better outcomes, including longer survival and less toxicity, but not all patients receive these drugs. The study authors noted that pay-for-performance programs in health care have historically shown mixed results, but insurers have implemented these programs as a way to improve the quality of care and decrease cost growth.

In oncology specifically, spending is largely driven by the high costs of cancer drugs and is expected to reach more than $170 billion in 2020. There are currently very few programs to improve care or reduce spending in this sector, according to the study.

A 3-year evaluation of Medicare’s Oncology Care Model program, for example, showed no significant impact on spending or utilization or emergency departments, hospitalizations, or cancer drugs. The Anthem Inc voluntary pay-for-performance program, called the Cancer Care Quality Program, is the first and largest to show a significant increase in evidence-based prescriptions in cancer care, according to the study authors.

In addition to the increase in prescriptions, the authors found that overall spending did not significantly change, although the amount spent on oncologic drugs over a 6-month period increased from $48,030 to $51,369, and patient out-of-pocket expenses increased from $2217 to $2470. The investigators also found significant variability in cancer drug prescribing among oncology practices, in which physicians prescribed 402 unique drug regimens, although just 60 of those were evidence-based regimens in the program.

According to the authors, both of these findings highlight the need for more interventions.

“The cost of cancer care is too high, just like other areas in health care,” said senior author Amol S. Navathe, MD, PhD, in a statement. “This program is a much-needed example of an effective program—one that improved quality of care for patients. As we look forward, we need to build on the success of this program to design programs that also decrease costs.”

REFERENCE
Enhanced reimbursement to oncology clinics increases prescriptions of evidence-based drugs [news release]. EurekAlert!; October 7, 2020. https://www.eurekalert.org/pub_releases/2020-10/uops-ert100720.php. Accessed October 13, 2020.