{"entity":{"id":"idea-acc-episode-payment-tied-to-concordance","kind":"idea","name":"Bundled episode payments for cancer care with bonuses for guideline concordance","aka":[],"tldr":"Pay hospitals a single amount for a whole course of cancer treatment, with extra for following the evidence, rather than paying per visit and per drug, which rewards fragmentation.","summary":"The US Oncology Care Model and its successor tested episode-based payment for chemotherapy episodes with quality measures; results on cost were mixed, but process measures improved. A design that ties a larger share of payment to guideline concordance, supportive care access, and avoidance of low-value end-of-life chemotherapy, while adjusting for case mix, could align incentives with coordination. This is a payer experiment, and needs careful attention to unintended effects.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Fragmented care and guideline gaps): Hanna et al., Mortality due to cancer treatment delay: systematic review and meta-analysis (BMJ 2020)","url":"https://doi.org/10.1136/bmj.m4087"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-care-fragmentation","b-incentive-misalignment","b-drug-pricing"],"keyPapers":["paper-hanna-bmj"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Episode payment with concordance bonuses will improve guideline-concordant care and reduce emergency visits and end-of-life chemotherapy without increasing total cost per episode.","rationale":"Fee-for-service rewards volume and fragmentation; bundles create a single accountable entity for the episode, which is the precondition for coordination.","test":"A randomised payer pilot across practices with concordance, utilisation, patient experience, and cost as endpoints, evaluated independently.","maturity":"being-tested-at-scale","actor":"payer","cost":"large","horizonYears":5},"route":"/ideas/idea-acc-episode-payment-tied-to-concordance/","neighbours":{"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}],"paper":[{"id":"paper-hanna-bmj","kind":"paper","name":"Mortality due to cancer treatment delay: systematic review and meta-analysis","route":"/key-papers/paper-hanna-bmj/"}]}}