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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.

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