HealthHelp and Humana investigate the impact of case rate payments on cancer care

June 6, 2016

A recently published study, Do Case Rates Affect Physicians’ Clinical Practice in Radiation Oncology?: An Observational Study, found no evidence that switching to case rate payments adversely impacts care. The study was conducted in collaboration with Humana, a national health plan.


The study examined how switching from fee-for-service payments to case rate payments affected treatment at one multi-site provider. Five types of cancer were examined: bone metastases, breast, lung, prostate, and skin cancer. Fee for service is the traditional method of payment in this industry, where physicians are paid based upon the amount of care delivered. Case rate payments, on the other hand, signify a shift toward value-based medicine, as physicians are paid one lump sum for a complete episode of care.

“Case rate payments are not widely used in radiation oncology, so it is important for us to understand their impact on the quality of care patients receive,” said HealthHelp outcomes researcher Adam C. Powell, Ph.D., the paper’s corresponding author. “We did not find any evidence that case rate payments adversely affected patient care at the provider group level.”


The authors found that after case rate payments were introduced, the under-treatment rate for all cancers declined from 4 percent to 0 percent while that the over-treatment rate remained unchanged at 9 percent. This suggests that case rate payments may not have a negative impact on cancer care.

The study’s authors compared the amount of care administered—measured in radiation fractions—in 2011, before case rate payments were implemented, and in 2013, after the implementation of the case rate payment program.


“As we implement innovative payment models, we want to measure and preserve quality and patient-centered delivery of care in the populations we serve,” said Bryan Loy, MD, MBA, Vice President – Oncology, Laboratory, and Personalized Medicine at Humana. “We are encouraged that the case rate model is sustainable and maintains patients’ interests.”

The authors of the paper note that additional research should be completed in the future to better quantify the impact of the case rate payment model and to assess its implications in other populations. As only one multi-site provider was examined, it is possible that the results may not be generalizable.

Access the full study here:

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