Oncology Value-based Care & Private Payers: What Exactly Is Going On?


Oncology Value-based Care & Private Payers: What Exactly Is Going On?

January 19, 2023

Welcome to the January 2023 edition of our Monthly Insight Series. This month we discuss value-based care in oncology from a private-payer perspective.

Writing report

Greetings from San Mateo!

Value-based care (VBC) is a popular topic across healthcare. A lot is being said, but what does it all mean? And how important is it in oncology specifically? With increased payer activity and diverse provider perspectives and incentives, VBC is a complex topic that we sought to unwind and investigate for our valued subscribers.

In December, we released our annual special topic report centered on VBC in oncology from a private-payer perspective. Our key questions include:

  • Why are payers, particularly vertical payers, so interested in VBC?
  • How are VBC programs impacting oncology?
  • What does the future of VBC look like and should manufacturers be paying attention?

Report Highlights

VBC ideally seeks to align payers’ and providers’ interests by moving away from incentivizing high volume, high cost care

  • Payer’s first priority for VBC is cost management
  • Most private payer VBC programs focus on low-risk, upside-only, vs. 2-side risk or capitation
  • Payers and providers’ priority of improvements in outcomes versus cost savings frequently differ, but VBC can narrow the gap by indirectly instilling a sense of “shopping cost sensitivity” for providers

Head over to our subscriber portal  to check out our latest extrospections about VBC in oncology. You can find this report under the “Special Report” tab, titled “2022 Special Topic Report – Oncology Value-based Care Private Payers”.

As always, please reach out with any comments or questions you have. 

All the best...
-- HMP Market Access Insights Team

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