Designing and implementing a payment system to support cancer care coordination: A literature review

Background: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. Methods: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline. 47 papers were finally retrieved, including 18 articles focusing on cancer care. Results: The review highlighted key issues in the design and implementation of an alternative payment model in oncology. First, some studies explained that the level of integration of the different stakeholders would condition the choice of the payment design. They advised that the enrolled caregivers had a prior experience of working together so that the payment could rely on already formalized care processes. Second, most papers insisted that healthcare professionals had to be included since the design phase to agree on a standardized care pathway that would be consistent with current guidelines. To do so, focus groups and semi-structured interviews conducted with professionals from the enrolled facilities, as well as payers and patient associations, were favored. Third, the review showed that economic evaluations were necessary to have an understanding of the episode costs and determine gain-sharing arrangements between caregivers as well as their respective financial accountability. Using a micro-costing approach and adopting a societal perspective to estimate direct, indirect and intangible costs were demanded. Contingent evaluations measuring professionals' willingness to participate in the payment scheme could serve as complementary analyses. Conclusions: The adoption of a new payment system would be strongly dependent on the design choices and implementation processes. A pilot study assessing its effectiveness in cancer care should bring important knowledge for policymakers willing to develop value-based payment systems in oncology.