Value-based payment, oncology and primary care — how can it all work together?

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A value-based payment model can drive collaboration between primary care physicians and oncologists to provide the best possible care for patients, said a former leader at the U.S. Centers for Medicare & Medicaid Services.

Elizabeth Fowler, JD, PhD, was a keynote speaker on May 6 at the 2025 NCCN Policy Summit: Primary Care and Oncology Collaboration for Better Patient Outcomes. The meeting was planned by the National Comprehensive Cancer Network (NCCN), a nonprofit alliance of 33 cancer centers.

Fowler, who has worked in both private and public sector settings, most recently served as CMS deputy administrator and director the Center for Medicare and Medicaid Innovation (CMMI) in the administration of President Joe Biden. There she oversaw payment and care delivery models that influenced value-based care on a national scale.

Elizabeth Fowler, PhD, JD
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Fowler’s speech was titled “Predicting the Unpredictable: The Future of Value-Based Care and Implications for Oncology.” She explained CMS’ Oncology Care Model (OCM), which ran from July 2016 to June 2022. That model was followed by the Enhancing Oncology Model, which began in July 2023 and continues through June 2030.

OCM was an ambitious effort to test whether value-based payment could work in one of the most complex, variable and high-cost medical specialties, Fowler said.

“OCM was transformative — it moved oncology into the value-based care conversation,” she said. CMS asked participating practices to improve patient engagement and focus on the whole patient, not just the treatment regimen. Shared decision making with primary care was not a standalone performance metric, but it was embedded in OCM’s design and implementation. OCM practices reduced payments compared to a control group, in part by reducing unnecessary acute care and substituting higher value treatments, and nearly broke even by the time it ended.

ECM followed to push further to address non-medical health needs. Both models promote better coordination of care within oncology practices, but do not directly address or evaluate integration with primary care, Fowler said. As a result, there will be opportunities to strengthen communication and shared accountability between oncologists and primary care physicians, especially for managing comorbidities and long-term survivorship.

‘Patients can’t be treated in fragments’

That means now is the time to shape the policy priorities and payment innovations that support collaboration between primary care and oncology, Fowler said.

“Organizations like NCCN are the stewards of evidence-based care, but you also have the opportunity to become enablers of implementation,” Fowler said. “In a value-based care world, guidelines aren't just about clinical decision making. They're also the guardrails that allow payers to align incentives, allow providers to make important trade-offs, and allow patients to get the right care at the right time.
“And so, if we want value-based care to work in community oncology, then pathways must also reflect cost, equity and real-world feasibility, in addition to clinical efficacy,” she said. “Clinical guidelines alone won't transform care. We also need to break down silos, especially the ones between, name your specialty, and primary care. Patients can't be treated in fragments and where oncology oversees the tumor, managing diabetes and hypertension becomes secondary, and although both OCM and EOM included screening for depression that comes with a diagnosis, we all also need to make sure that it is managed. In a value-based care world, we need a model of shared accountability where oncology and primary care work together to care for the whole person.”

Cancer care of the future

The CMS models asked if value-based care can work in oncology. The better question may be whether oncology will lead the way in making value-based care and integrated care work, Fowler said.

She noted she does not have a crystal ball to predict the future, but she did have some convictions about care:

• Value-based care in oncology is maturing and expanding, but not fast enough.
• Clinical leadership is essential. Oncologists have been at the table to shape payment and care models, but they must be even more and make oncology an example for integration of care.
• Public-private collaboration is more important than ever. Health systems, life sciences companies, commercial payers, researchers and patient advocates all must contribute to creation of payment models.

A chance to share responsibility

Fowler began her speech noting the tension and uncertainty that seems pervasive in today’s environment, and she returned to that theme as she concluded. Many of the physicians and researchers were directly or indirectly facing cuts to federal funding, which has the potential to undermine the ecosystem that undermines the next breakthrough therapies.

“We might not know exactly what the future holds, but we have the tools, the data, the expertise, and most importantly, the collective will to shape the future for the better,” Fowler said. “And so we shouldn't wait for someone else to define value.

“Value-based care doesn't just mean financial risk and shared savings,” she said. “Let's make it about shared responsibility between oncology and primary care, between hospitals and communities, and between science and compassion. Value-based care is a patient-centered, full-person approach to caring for patients, and that requires every part of the system working together.”