Cancer Episode Payment Model for Cancer Care

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Disqualifiers: Non-Hawaii Oncology providers

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how a new payment model for cancer care, the Cancer Episode Payment Model (CEM), can improve health outcomes and reduce costs for chemotherapy patients in Hawaii. It compares two groups: one where oncologists receive payments based on the patient's overall care, and another where they are paid for each service provided. The goal is to determine if different payment methods help doctors deliver better care while reducing costs. Doctors from Hawaii Oncology are participating in this trial to explore this new payment approach. As an unphased trial, this study offers a unique opportunity to participate in innovative research that could transform cancer care payment systems.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that the Cancer Episode Payment Model is safe for cancer care?

Research on similar payment models shows they aim to improve collaboration among healthcare providers without compromising treatment safety. Studies have found that models like the Cancer Episode Payment Model (CEM) focus on managing costs and enhancing care quality for cancer patients. These models primarily address financial and care coordination aspects, not new medical treatments or drugs.

Since this trial examines a payment method rather than a medical treatment, it poses no direct safety concerns for patients. The main goal is to determine if improved teamwork among healthcare providers can enhance patient outcomes and reduce costs. No reports of negative medical events have been linked to this payment model approach.

In summary, this model concerns payment management, not altering medical care. It emphasizes ensuring patients receive well-coordinated care, potentially leading to better health outcomes. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Cancer Episode Payment Model (CEM) because it represents a shift from traditional fee-for-service payment methods in cancer care. Unlike standard payment models where oncologists are paid per service, CEM offers payments based on a patient's entire episode of care, which spans six months. This model incentivizes high-quality care by offering performance-based payments linked to six quality metrics. By focusing on overall care quality rather than individual services, CEM has the potential to improve patient outcomes and reduce unnecessary treatments. Researchers hope to discover whether this approach leads to better health results and more efficient use of healthcare resources.

What evidence suggests that the Cancer Episode Payment Model is effective for cancer care?

Research has shown that the Cancer Episode Payment Model (CEM), tested in this trial, yields promising results. Participants will join one of two groups: the CEM arm, where oncologists receive payment for each member's episode of care, or the Fee for Service arm, where traditional payment methods continue. Studies have found that models like CEM reduced total costs by $297 compared to traditional payment methods. These models also saved money by reducing hospital stays at the end of life. Importantly, patient satisfaction remained unchanged, indicating that the quality of care did not decline. Overall, the CEM approach aims to save money without affecting patient care. ^{2 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for oncologists in Hawaii who are part of the Hawaii Oncology network and treat HMSA members with lung, colorectal, breast, or colon cancer using chemotherapy. It's not open to providers outside this group.

Inclusion Criteria

Any oncologist who practices with Hawaii Oncology and is a participating provider.

Exclusion Criteria

Any provider who does not practice with Hawaii Oncology.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive care under the Cancer Episode Payment Model for 6 months

6 months

Follow-up

Participants are monitored for quality of care and survival outcomes

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Cancer Episode Payment Model (CEM)

Trial Overview The trial is testing a new payment model called Cancer Episode Payment Model (CEM) that aims to improve care coordination for cancer patients undergoing chemotherapy and see if it can reduce healthcare costs while improving outcomes.

How Is the Trial Designed?

Group I: Cancer Episode Payment Model Experimental Treatment 1 Intervention

Oncologists in this arm will be paid for each member's episode of care. The episode of care is 6 months in duration. Oncologists will have the opportunity to receive performance-based payments based upon a set of 6 quality metrics.

Group II: Fee for Service Active Control 1 Intervention

Oncologists in this arm will not receive the intervention and will continue to be paid through fee-for-service.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Hawaii Medical Service Association

Collaborator

Trials

4

Recruited

240+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10398163/

Modeling Episode-Based Payments for Cancer Using ... RESULTS: The adapted OCM-like model was applied to data from 39,967 patients with 1 of 4 cancer types. Approximately 13% of patients had at least 1 episode ...

2. jamanetwork.com jamanetwork.com/journals/jama-health-forum/fullarticle/2800747

Enhancing Oncology Model for Cancer Bundled Payments ... Small end-of-life cost savings were derived from a 1% reduction in hospitalizations. Patient satisfaction was found to be unchanged. The OCM did ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8579232/

Association of Participation in the Oncology Care Model ... The OCM was associated with a statistically significant $297 decrease in total episode payments relative to comparison episodes (90% CI, −$504 to −$91; P = .02) ...

4. cms.gov cms.gov/priorities/innovation/data-and-reports/2023/ocm-evaluation-pp1-9-exec-sum

Evaluation of the Oncology Care Model Episode payments for Part B non-chemotherapy drugs increased significantly less in OCM episodes than in comparison episodes, reflecting more.

5. cms.gov cms.gov/priorities/innovation/media/document/eom-elec-pat-rpt-outcomes

EOM Electronic Patient-Reported Outcomes Guide This document is designed to guide Enhancing Oncology Model (EOM) participants in the gradual implementation of collecting and monitoring ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11667361/

Medical and Surgical Episodes Among Hospital ... BPCI-A participation was associated with a decrease in Medicare payments of $882 per episode for medical episodes and $587 per episode for surgical or ...

7. ascopubs.org ascopubs.org/doi/10.1200/JCO.24.00502

Association of Participation in Medicare's Oncology Care ... From the pre-OCM to the OCM period, mean total episode payments increased from $45,504 in US dollars (USD) to $46,239 USD for OCM-participating ...

8. cms.gov cms.gov/priorities/innovation/innovation-models/oncology-care

Oncology Care Model The Oncology Care Model, which aimed to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare.