Three-Year Results of a Medicare Advantage Cancer Management Program

Area of Science:

• Oncology
• Health Services Research
• Health Economics

Background:

• Cancer care reform aims to balance cost control with quality improvement.
• Payer-provider collaborations are emerging models for value-based care.
• Integrating patient support services can enhance care delivery.

Purpose of the Study:

• To evaluate a payer-sponsored oncology program designed to reduce total costs and improve patient care.
• To assess the impact of evidence-based treatment pathways and patient support on healthcare expenditures.
• To determine the feasibility and outcomes of a collaborative cancer care model.

Main Methods:

• A 3-year study (2013-2016) enrolled 746 Medicare Advantage patients with common cancers.
• Oncology nurses provided patient support, symptom assessment, and advance care planning introductions.
• Cost savings were calculated by comparing the study group with a matched cohort, analyzing drug, hospitalization, and ER costs.

Main Results:

• Cumulative cost savings reached $3,033,248, with increasing annual savings.
• Significant drug cost savings of $1,874 per patient per treatment month were observed.
• High adherence to treatment pathways (up to 90%) and patient satisfaction (94%) were maintained.

Conclusions:

• Practice-based, payer-supported programs can effectively reduce cancer care costs.
• The model demonstrated success in maintaining high adherence to treatment pathways and patient satisfaction.
• This approach offers a viable strategy for improving value in oncology care for older adults.