Expert consensus on essential characteristics of oncology value-based payment

Value-based payment (VBP) models are increasingly adopted in oncology to promote high-quality, cost-effective, and patient-centered care. To identify essential characteristics of effective oncology VBP models, a modified Delphi process was conducted with 9 experts representing diverse oncology organizations. Panelists participated in 2 survey rounds and an in-person discussion, evaluating the importance and feasibility of key VBP model elements using Likert scales. Results revealed consensus on the need for patient-centered care, robust risk adjustment, and oncology-specific outcome measures. While pay-for-performance and enhanced monthly payment models were seen as feasible and widely used, they were also criticized for outdated metrics, insufficient reimbursement, and high administrative burden. High-impact models such as dual-sided risk and cost-containment approaches were viewed as promising but challenging to implement, particularly for small or rural practices. Panelists cited stakeholder misalignment, financial risk, and lack of standardized benchmarks as major barriers to effective implementation. The authors concluded that future VBP models must align incentives across stakeholders, accommodate clinical complexity, and evolve iteratively to support innovation, equity, and sustainability in oncology care.