Boost your practice’s value-based care model and earn rewards when you help reduce the total cost of care. The Cancer Episode Program is a voluntary bundled payment program that modifies the standard fee-for-service payment system with a prospective, episode-based bundled payment (or episode fee) for 4 months of outpatient treatment.
Age 19 or older with primary coverage commercial plans that require prior authorization for cancer therapies1
Patients who receive intravenous/injectable chemo with specific cancer diagnoses
Breast, colorectal and lung cancer of any stage
Most metastatic, solid tumor cancers
Certain hematologic syndromes/malignancies
Central nervous system cancers
Can be a private practice or hospital-based oncology health care professional
Has an existing contract with UnitedHealthcare,1 and signs a contract amendment for the program (renewable every 3 years)
Patients can be treated with any National Comprehensive Cancer Network (NCCN)-approved regimen for the specific cancer and stage
UnitedHealthcare plays no role in determining which treatment plan oncologists choose
How to participate
Email UnitedHealthcare to indicate you’d like to participate1. Include your practice/facility name, tax ID number(s) and contact information in your request.
We’ll set up time to answer any questions, review the contract amendment and determine a program effective date.
Once you return the signed amendment, your enrollment will be confirmed within 1 week.
During the program kick-off meeting, we’ll work with you to identify your patients who will be automatically enrolled on your program effective date. Patients must be enrolled in a UnitedHealthcare commercial plan that requires prior authorization for cancer therapies. Patients may be excluded for certain customer plans, UnitedHealthcare entities or third-party arrangements.
UnitedHealthcare reserves the right to change, cancel or modify the program and its features, including reward eligibility, at any time and to temporarily suspend the program at any time without prior notice. If there is any suspected fraud or abuse, UnitedHealthcare reserves the right to stop or discontinue reward payment(s).
1See Program Manual for additional detail on rules. This is not an exhaustive list and is subject to change. Eligibility varies by health plan and state and is subject to all applicable laws and regulations.