Philadelphia, PA—
Money talked, and medical specialists listened in a recent pay-for-performance program that offered enhanced reimbursement to oncology practices for prescribing high-quality, evidence-based cancer drugs.

The report published online by the Journal of Clinical Oncology said use of the drugs increased without significantly changing total spending on care. 

University of Pennsylvania–led researchers tout their study as the first to demonstrate how a national insurer’s voluntary pay-for-performance program can change prescribing patterns among oncologists to deliver higher-quality cancer care.

“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 colead author Justin E. Bekelman, MD, director of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center, a professor of Radiation Oncology in the Perelman School of Medicine at the University of Pennsylvania, and senior fellow at the Leonard Davis Institute for Health Economics. “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.”

Background information in the articles points out that cancer-drug prescribing by medical oncologists “accounts for the greatest variation in practice and the largest portion of spending on cancer care.”

The study team evaluated the association between a national commercial insurer’s ongoing pay-for-performance (P4P) program for oncology and changes in the prescribing of evidence-based cancer drugs and spending.

Using administrative claims data covering 6.7% of U.S. adults, researchers included adults with breast, colon, or lung cancer who were prescribed cancer-drug regimens by 1,867 participating oncologists between 2013 and 2017. Defined as the primary outcome was whether a patient’s drug regimen was a program-endorsed, evidence-based regimen; the authors also evaluated spending over a 6-month episode period.

Results indicate that the P4P program was associated with an increase in evidence-based regimen prescribing from 57.1% of patients in the preintervention period to 62.2% in the intervention period, for a difference of +5.1 percentage points (95% CI, 3.0 percentage points to 7.2 percentage points; P <.001). 

Researchers point out that the P4P program was also associated with a differential $3,339 (95% CI, $1,121- $5,557; P = .003) increase in cancer-drug spending and a differential $253 (95% CI, $100- $406; P = .001) increase in patient out-of-pocket spending, but no significant changes in total healthcare spending ($2,772; 95% CI, ?$181-$5,725; P = .07) over the 6-month episode period. “P4P programs may be effective in increasing evidence-based cancer drug prescribing, but may not yield cost savings,” the authors conclude.

The study explains that evidence-based cancer regimens are linked to better outcomes, including longer life and less toxicity, yet not all patients receive them.

“The cost of cancer care is too high, just like other areas in health care,” said senior author Amol S. Navathe, MD, PhD, an assistant professor of Medical Ethics and Health Policy and the Healthcare Transformation Institute, and a senior fellow at the Leonard Davis Institute for Health Economics at Penn. “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.”

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