# Comparing Targeted and Non-Targeted Approaches to Improving the Value of Cancer Care Services

> **NIH AHRQ R01** · HARVARD MEDICAL SCHOOL · 2020 · $371,800

## Abstract

Amidst the revolution in personalized medicine and an exploding pipeline of new biologic treatments aimed at
improving cancer outcomes while also decreasing the side effects of treatment, the cost of cancer care
nationally is among the fastest growing segments of health care costs. Efforts to control escalating costs of
care either can use more general payment reforms to encourage providers to change their overall approach to
care or be targeted explicitly at specific clinical areas such as oncology. The Medicare Accountable Care
Organization (ACO) programs represent the most important effort nationally to test the impact of a global
payment model that is not focused on a particular clinical area. In contrast, in the area of cancer care, CMS
launched in 2016 the Oncology Care Model (OCM), which is a targeted bundled payment approach that holds
participating practices accountable for spending for a 6-month episode that is triggered by the receipt of
chemotherapy. Both of these approaches provide flexibility for provider systems to customize treatment
approaches while also providing strong incentives to reduce overuse of expensive and/or low value health care
services that are not supported by good evidence. Yet, no data are available on the effectiveness of either
approach for improving the value of cancer care delivery or of the comparative effectiveness of the two
approaches. To date, over 500 participants have contracted with Medicare to participate in either the Pioneer
or Medicare Shared Savings (MSSP) ACO programs and almost 200 oncology practices began participating in
the OCM in July 2016. In previous work, we found that the first year of the ACO programs saved ~1% in overall
costs through both use of less expensive care settings and decreased utilization of services, but savings were
larger in year 2. The overall purpose of this research is to determine whether non-targeted payment reform
policies such as those being used in the Medicare ACO program will be successful in promoting high value
delivery of oncology services, including both abandonment of unproven therapies and adoption of proven, but
historically underused ones, and to compare this with the targeted approach of the OCM. Our proposal has
three specific aims that assess (1) the effects of ACOs on spending on cancer-related services overall, (2) the
effects of ACOs on use and de-adoption of low value non-evidence-based services and use of high value
services such as hospice and palliative care, and (3) comparison of these outcomes for ACO and OCM
participants. Our proposed work will provide a nuanced understanding of the effect of global and targeted
payment reforms on spending and the use of services for cancer patients. As new and ever more costly drugs
and treatment approaches are developed, health care organizations will need to develop strategies to ensure
that such costly treatments are used only when their net benefits justify the high cost. The scientific premise of
our...

## Key facts

- **NIH application ID:** 9895590
- **Project number:** 5R01HS026498-02
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Bruce E. Landon
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $371,800
- **Award type:** 5
- **Project period:** 2019-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9895590

## Citation

> US National Institutes of Health, RePORTER application 9895590, Comparing Targeted and Non-Targeted Approaches to Improving the Value of Cancer Care Services (5R01HS026498-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9895590. Licensed CC0.

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