Policy Priority: Improve and Facilitate the Quality of Cancer Care
Advancing Value-Based Models of Care in Oncology
In pursuit of reduced healthcare costs and improved quality of care, the United States healthcare infrastructure is transitioning from a traditional fee-for-services (FFS) reimbursement model to value-based reimbursement. Value-based models seek to encourage cost-effective, high-quality care in a complex treatment environment. NCCN supports the advancement of value-based models in oncology to ensure people with cancer have access to the highest quality of care and health systems benefit from the most efficient use of resources possible. In order to manage costs while preserving optimal care, NCCN supports value-based models that:
- Incentivize clinician payment based on quality and value of care over quantity of services;
- Adopt provisions requiring participating providers and vendors to adhere to nationally recognized, continuously updated, professional society guidelines in treatment decisions;
- Remain voluntary to ensure only practices with appropriate infrastructure and enthusiasm are included in the model;
- Provide selected practices and suppliers with adequate time to reallocate resources to meet model demands;
- Provide timely and actionable feedback to guide improvement;
- Consider provider and patient burden when installing administrative processes; and
- Provide mechanisms such as novel therapy adjustments paired with required adherence to nationally recognized guidelines, ensuring that innovative, potentially curative, therapies are not dis-incentivized when clinically appropriate.
NCCN strongly encourages the adoption of value models in oncology that adhere to the aforementioned principles to advance high-value cancer care.
Please see relevant NCCN policy statements below:
- NCCN Response to HHS Notice of Benefit and Payment Parameters for 2021 (February 2020)
- NCCN Response to CMS Oncology Care First Model: Informal Request for Information (December 2019)
- NCCN Response to CMS Request for Information on the Future of Program Integrity (November 2019)
- NCCN Response to Proposed Radiation Oncology Model (September 2019)
- NCCN Response to Senate HELP Request for Innovative Solutions to Drive Down Costs in Healthcare (March 2019)
- NCCN Response to the International Pricing Index ANPRM (December 2018)
- NCCN Response to CMS CY 2019 Physician Fee Schedule Draft Rule (August 2018)
Quality
NCCN supports the use of evidence-based, nationally recognized, guidelines to ensure people with cancer receive quality care while reducing cost and clinical burden. Recently the NCCN Quality & Outcomes Committee reviewed the existing quality landscape and identified contemporary, relevant, cancer quality and outcomes measures by both evaluating current validated measures and proposing new measure concepts to fill crucial gaps. This work will be a resource in quality measurement in oncology. In order to use quality measures to improve care and outcomes for people with cancer, NCCN affirms that:
- Nationally-recognized, continuously-updated clinical practice guidelines are a key tool for quality programs to protect patient access to the highest standard of care;
- Quality measurement must be informed by a variety of key stakeholder perspectives including patients, providers, payers, and health information technology vendors to ensure representative and meaningful measurement; and
- Quality measurement must be easily available through a variety of interoperable digital platforms to ensure minimal administrative burden and ease of integration into clinical workflow.
In addition to the aforementioned statements, NCCN supports the alignment of similar, effective, measures in the quality space when and where possible.
Please see relevant NCCN policy statements below: