Perspective Private Payers and Cancer Care: Land of Opportunity

The costs of cancer care are unsustainable in the present US health care system. Private payers have taken a leading role in oncology payment reform. This benefits all payers, including the Center for Medicare and Medicaid Services (CMS). Private payers ’ ability to set up systems of mea-surement and quality improvement is a strategy to sup-port pay-for-value contracting. This facilitates workflow changes in oncology office practice as a way to bend the cost trends while enhancing patient care. Oncology prac-titioners demand speed and flexibility in deploying custom-ized information technology solutions in exchange for new contracting terms. Pathway and guideline support tools have been proven effective in validating the use of evi-dence-based medicine and in systematizing office opera-tions to reduce avoidable costs. The future of oncology practice should see further enhancement of these capabil-ities. A common health information exchange pipeline will allow patients, physicians, and other health care providers to share structured information from multiple electronic medical record/electronic health record platforms. By al-lowing multiple payers, including CMS, to access com-monly accepted clinical decision support rules, any payer can create contracts and relationships with oncology prac-tices. In this manner, future changes in payment for oncol-ogy services mandated by CMS can be sustained within the infrastructures being built today through payer-pro-vider collaborations