Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.



Chemotherapy in commercial VBC: 5 opportunities (and 1 area to avoid)

In our recent analysis of a national commercial data set of professional claims, chemotherapy was the fifth highest-cost sub-service line—and that doesn’t even take drug costs into account. Many of the experts we interviewed were surprised how high chemotherapy was on the commercial list.

There is a clear savings opportunity for chemotherapy under value-based care, but this opportunity comes with reservations. Cancer is personal and scary. The more personal an issue is, the less employers want to get involved—and the less patients (employees) want their employers involved.

But there’s good reason for plans, providers, and employers to work together to address cancer costs. Spending on chemotherapy for the commercial population doubled from 2014 to 2019. And overall cancer spending is projected to increase by 34% from 2015 to 2030. Below, we’ve outlined three well-vetted strategies to prioritize, two emerging opportunities to consider, and one area to completely avoid.

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The future of value-based care

Medicare and Medicaid risk is progressing (slowly) – but commercial risk will determine whether the industry tips toward a new cost and quality standard.


3 tried-and-true strategies

Shift care to non-hospital infusion sites whenever possible.

Adopt generic and biosimilar chemotherapy regimens.

Deploy nationally recognized clinical pathways to reduce care variation.


2 emerging opportunities
  • Overcome home-based infusion obstacles to reduce costs and improve patient satisfaction.
  • Stay aware of the growing promise—and cost—of genetic and biomarker testing.

1 area to avoid
  • Don’t create payer-provider-employer partnerships focused on reducing pediatric chemotherapy costs.

Parting thoughts

As the fifth highest-cost sub-service line, chemotherapy must be part of any commercial value-based care strategy. Efforts to reduce chemotherapy spend must keep the health of the patient as the central focus. But as we’ve detailed above, there are areas to target right away and areas to track.

Any conversation related to costs in cancer care evokes an urgent question: How do we slow the unsustainable rise in cancer drug costs? Payment complexity makes this hard to do. Learn about new cost-control methods in cancer care and other key trends in our Oncology State of the Union.

More commercial claims analysis:

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