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Integrated Delivery Networks’ Emerging Influence on Cancer Care

By: Deni Deasy Boekell, Senior Director, Commercial Strategies & Market Access, Kantar Health

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Market forces continue to drive oncology practices to align, invest and adapt to capture patient volume, adjust to decreasing payer reimbursement, optimize revenue, and reduce financial risk.

Affiliation with or even acquisition by an integrated delivery network (IDN) is an attractive option for many practices, offering access to increased patient volume, higher reimbursement through the institution, protection from carrying costs and patient cost-share risk, reduced administrative burden, and inclusion in payment models moving toward integrated patient care.

According to our survey of 150 independent community-based and 80 hospital-owned or -affiliated oncology practices, 35% of independent community oncology practices engaged in some form of business association within the past two years; the majority were affiliations with a hospital/IDN. In addition 22% of oncology practices are considering affiliation with an IDN in the next 24 months.

This means more and more cancer patients are receiving their care through an IDN-affiliated or -owned practice, and those practices are leading investment in capabilities, reimbursement and business models. This shift in oncology care through IDNs is affecting patient treatment in three ways: increasingly centralized management of oncology, focus on cost effectiveness catalyzed by novel reimbursement, and adaptations to increased patient involvement in care planning.

1. IDN centralized management of affiliated oncology practices

Centralized management is being implemented through increasing CPOE/decision support tools to help select drugs, the use of pathways with management controls (e.g., step requirements), and centralized drug acquisition and/or formulary. More than 80% of IDN practice respondents reported being subject to IDN mechanisms that affect prescribing.

IDNs most often use decision support tools, centralized drug formularies and pathways to direct oncologists toward preferred therapies. Pathways are a key mechanism by which IDNs may influence oncologists’ treatment decisions, and IDN oncologists are more likely to be exposed to pathways than are their independent community practice colleagues.

2. Increasing focus on cost effectiveness catalyzed by novel reimbursement

Almost half (46%) of IDN oncologists reported participating in an accountable care organization (ACO) in 2016 (up from 40% in 2015), affecting one-third of their patients on average. ACO-participating IDN practices are more likely to focus on cost-effective treatments, reduction in redundant care, and the quality of life for their ACO patients.

3. Adaptation to increased patient involvement in care planning

While IDN practices most often direct patients with cost concerns to financial support, they do so less frequently than independent community practices. The IDN oncologists are also increasingly looking to less costly drug alternatives in response to affordability issues.

Of note, the 26% response indicating use of less costly drug options in the IDN is up from 13% in 2015.

IDN oncologists are more likely to have end-of-life planning discussions with patients (frequently triggered by changes in patient status) and to have these discussions result in reductions in the use of therapeutic options for most of these patients.

IDNs are structurally different from community practices, and these differences are influencing traditional cancer care delivery and decision making. Given the growing importance of IDNs in oncology care, it’s important to understand how this shift will change cancer care delivery and patient care.

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