The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
A bipartisan group of state health policymakers from both the executive and legislative branches who are focused on improving population health.
Supporting networks of state officials, advocates, and others aiming to invest in and transform primary care.
Advancing state-based efforts to make health care more affordable for residents, employers, and states.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
Improving state leaders ability to enact and implement evidence-based health policies.
Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
Our state health policy resources provide relevant data analysis and best practices.
The Fund publishes reports, issues briefs, and case studies on state health policy issues.
Short takes on health policy issues from Milbank staff and guest authors.
Insights from Milbank President Debra Lubar on state health policymaking.
Reported articles and Q&As on timely health policy issues, as well as foundation updates.
Upcoming and past Milbank Memorial Fund and Milbank Quarterly webinars featuring state health policymakers and researchers.
Updates and expert contact information for reporters.
The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
March 2017 (Volume 95)
Quarterly Article
James C. Robinson
Sep 14, 2026
Sep 9, 2026
Back to The Milbank Quarterly
Policy Points:
Context: High-value oncology requires physicians to monitor and coordinate all aspects of care, educate and engage their patients, and adopt cost-effective drug treatments. However, oncology practices in the United States traditionally have been reimbursed based on the number of office visits performed and through cost-plus margins from prescription of expensive drugs. Public and private payers now are experimenting with methods of payment that include monthly care management fees, annual bonuses, and incentives for conservative choice among alternative drug regimens.
Methods: This paper uses case study methods to examine oncology payment initiatives at Medicare, Anthem, Aetna, and UnitedHealthcare, the nation’s largest public and private health insurance plans.
Findings: The 4 insurers supplement traditional fee-for-service payment with payment methods designed to promote coordination of care and conservative use of health care resources. Medicare, Aetna, and UnitedHealthcare reward oncology practices that reduce per-patient spending, targeting unnecessary patient visits to emergency departments and hospitals. Anthem offers monthly payments to practices that adhere to lower-cost drug treatment pathways; Aetna increases the percentage markup on low-cost generic chemotherapies but not on high-cost biologics; and UnitedHealthcare removes the linkage between physician payment and spending on office-infused drugs. As a condition for receiving the new payments, each of the initiatives requires participating practices to report and, in some cases, improve performance on quality metrics. None of the initiatives bundles payment for oncology drugs together with payment for other oncology services, out of concern for shifting financial risk onto physicians and creating access barriers for patients.
Conclusions: The emerging “value-based” methods of oncology payment supplement fee-for-service and cost-based reimbursements with per-month and per-episode payments, but none of the payers bundle spending on cancer drugs with payments for other services. Payers recognize that bundled payment could create access barriers for patients and undermine innovation in effective but expensive new pharmaceuticals.
Author(s): James C. Robinson
Keywords: value-based payment, episode-of-care payment, oncology medical home, clinical pathways.
Read on Wiley Online Library
Volume 95, Issue 1 (pages 184–203) DOI: 10.1111/1468-0009.12249 Published in 2017