Private Shared Savings Model Lowers Colon Cancer Costs Without Reducing Utilization
A recent quasi-experimental study provides new insight into how private payer–based shared savings programs (SSPs) can help reduce oncology treatment costs without compromising adherence to evidence-based care. The analysis focused on a 3-year SSP pilot involving 2 large practices within the US Oncology Network. Under this model, participating providers received performance-based payments if they delivered care below cost benchmarks while following jointly defined clinical pathways. Unlike the discontinued Oncology Care Model (OCM), the SSP offered no upfront per-patient subsidies, relying solely on retrospective cost-savings incentives.
Using a difference-in-differences design, the study analyzed claims data from September 2014 through August 2017 for patients with breast, colon, and lung cancer. Researchers compared pre- and post-intervention cost and utilization trends among patients covered by the insurer at participating practices versus nonparticipating practices within the network. The findings showed a significant reduction in monthly per-patient total costs for patients with colon cancer in both the first year ($1391; P < .01) and second year ($1826; P < .01) of the program. Reductions in drug costs for colon cancer patients also deepened over time. These results suggest sustained efficiency gains in settings where clinicians have access to lower-cost but clinically appropriate alternatives, such as biosimilars or more selective use of supportive care agents.
For patients with lung cancer, a $1050 reduction in monthly total costs was observed in the first year (P = .02), but the savings did not persist into the second year. The authors note that these results may reflect the rapid adoption of expensive therapies such as immune checkpoint inhibitors during the study period, which limited opportunities for cost-effective substitutions. No significant cost effects were observed among patients with breast cancer, likely due to a narrower range of treatment options and limited discretion in therapy selection during the study timeframe.
The study found no evidence that the SSP altered patient visit frequency or overall utilization patterns, suggesting that cost reductions were driven primarily by treatment choices rather than reductions in care access. While the study did not measure quality outcomes directly, its design required participating practices to adhere to best-practice pathways, providing some assurance that quality standards were maintained.
These findings highlight the potential of private SSPs to support oncology cost containment, particularly in cancer types where lower-cost treatment alternatives are available and clinically appropriate. The results also underscore the importance of tailoring value-based models to specific tumor types to account for differences in therapeutic flexibility. Although the SSP design lacked the upfront investment of the OCM, it may represent a more sustainable model for achieving value in cancer care. As treatment paradigms and drug costs continue to evolve, further research is warranted to understand how private payer models can drive targeted, long-term cost savings across oncology.
Reference
Walker B, Wilfong L, Robert N, Sieber A, Hoverman JR. Utilization and costs among oncologists participating in a private insurance shared savings model. Am J Manag Care. 2025 June;31(6).
