{"entity":{"id":"idea-prev-pay-for-prevention-outcomes","kind":"idea","name":"Pay insurers and health systems for cancers prevented and caught early","aka":[],"tldr":"Health systems earn from treating cancer, not preventing it. Paying them for lower cancer incidence and earlier stage in their population would flip the incentive.","summary":"Health systems earn from treating cancer rather than preventing it, so this idea pays capitated insurers and health systems for cancers prevented and caught early, through outcome payments tied to population stage distribution, HPV vaccination coverage and smoking prevalence, adjusted for risk. Fee-for-service rewards volume, whereas outcome-based contracts change practice in other areas of care. The aim is higher screening and vaccination coverage and a stage shift towards stage I-II. The test is a payer pilot of a prevention outcomes bundle in a capitated system such as a Medicare Advantage plan or an NHS integrated care board. Speculative in maturity, it addresses the bottlenecks Prevention we already have is not deployed and Incentives reward me-too drugs and marginal gains.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Prevention we already have is not deployed): Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018)","url":"https://doi.org/10.3322/caac.21440"}],"tags":[],"related":[],"cancers":[],"sections":["prevention"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["stage-shift"],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption","b-incentive-misalignment"],"keyPapers":["paper-islami-ca-cancer-j-clin"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Outcome payments raise screening and vaccination coverage by at least 10 points and shift stage at diagnosis toward stage I-II by at least 5 points within five years.","rationale":"Fee-for-service rewards volume; outcome-based contracts change behaviour in other areas of care.","test":"Pilot in a capitated system (a Medicare Advantage plan or NHS integrated care board).","maturity":"speculative","actor":"payer","cost":"medium","horizonYears":5},"route":"/ideas/idea-prev-pay-for-prevention-outcomes/","neighbours":{"section":[{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"term":[{"id":"stage-shift","kind":"term","name":"Stage shift","route":"/terms/stage-shift/"}],"bottleneck":[{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"}],"paper":[{"id":"paper-islami-ca-cancer-j-clin","kind":"paper","name":"Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States","route":"/key-papers/paper-islami-ca-cancer-j-clin/"}]}}