From Fee-for-Service to Value: Evaluating Alternative Payment Models for Novel Oncology Care Access

Abstract

As cancer treatments become more complex and costly, traditional reimbursement models that reward volume rather than value create significant challenges for patients, providers, and health systems. In response, alternative payment models have emerged to better align financial incentives with quality care, affordability, and outcomes. However, their adoption in oncology remains uneven, especially for innovative therapies such as gene- based treatments and immunotherapies. This systematic review examines two questions: (1) What is the current status of oncology-focused alternative payment models in the United States? and (2) How do these models influence patient access to novel treatments? A structured literature review was conducted using three major databases and guided by a five-dimensional access framework that includes availability, accessibility, accommodation, affordability, and acceptability. Forty eligible studies were thematically analyzed. The results identified four dominant themes: clinical pathways, value-based care, quality measurement, and barriers to implementation. While models such as the Oncology Care Model and the Enhancing Oncology Model show promise in improving coordination and lowering costs, they often fall short in addressing access gaps, particularly in underserved communities. This review offers a new stakeholder- informed process model and highlights the need for proactive planning, standardized metrics, and cross-sector collaboration to ensure that future models are equitable, scalable, and capable of supporting continued innovation in oncology care.