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Designing a commercial medical bundle for cancer care: Hawaii Medical Service Association's Cancer Episode Model.

Urwin JW, Caldarella KL, Matloubieh SE, Lee E, Mugiishi M, Kohatsu L, Yoshimoto J, Tom J, Okamura S, Wang E, Zhu J, Emanuel EJ, Volpp KG, Navathe AS, Navathe AS. Designing a commercial medical bundle for cancer care: Hawaii Medical Service Association's Cancer Episode Model. Healthcare (Amsterdam, Netherlands). 2020 Jun 1; 8(2):100422.

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Abstract:

BACKGROUND: Oncology care is expensive and exhibits substantial variation in cost and quality across clinicians and patients. Unlike many conditions with established bundled payment programs, cancer care includes a mix of inpatient and outpatient care that precludes hospital-based designs. In 2018, we worked with Hawaii Medical Service Association (HMSA), the Blue Cross Blue Shield of Hawaii, to design a novel commercial bundle for cancer care, the Cancer Episode Model. METHODS: Descriptive analysis of HMSA's Cancer Episode Model, including its inclusion criteria, episode definitions, suite of enhanced services, shared savings model, and incentivized quality metrics. We also compare HMSA's Cancer Episode Model to Medicare's Oncology Care Model and three major commercial oncologic alternative payment models offered by Anthem, UnitedHealthcare, and Aetna. RESULTS: HMSA's Cancer Episode Model builds upon the successes and limitations of Medicare's Oncology Care Model and existing commercial alternative payment models. Compared to Medicare's Oncology Care Model, HMSA's Cancer Episode Model has stricter inclusion criteria, fewer incentivized quality metrics, a higher proportion of regional pricing, a different risk-adjustment model, and first-dollar shared savings. Compared to the majority of existing commercial models, HMSA's Cancer Episode Model includes total cost of care and a different risk-adjustment model. CONCLUSIONS: Reviewing features of the Cancer Episode Model in comparison to other programs is intended to provide guidance to health plans and health policymakers in the design of programs and policies aimed at improving cancer care value. LEVEL OF EVIDENCE: Level IV.





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