Rethinking Cancer Attribution in Value-Based Oncology Care
In this interview, a guest expert discusses research presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting on how the growing use of oral oncolytics and the increasing prevalence of concurrent cancers may expose limitations in current value-based care attribution methods.
Please share your name, title, and a brief overview of your professional history.
Jill Hellmann, MSN, RN: My name is Jill Hellmann. I am a value-based care transformation lead on the Payer Transformation and Strategy Team for The US Oncology Network.
My background is in nursing. I have been a nurse for almost 20 years, with experience in inpatient nursing, surgery, and several other areas before specializing in oncology.
Since then, I have continued to advance within oncology, with a particular focus on quality improvement and practice participation in value-based care models. That path ultimately led me to my current role as a transformation lead for The US Oncology Network.
Please share an overview of the abstract you presented at ASCO 2026?
Hellmann: Broadly speaking, the abstract focuses on how we can capture a clearer clinical picture of patients within value-based care models.
Historically, value-based care models have relied on evaluation and management (E/M) billing codes to identify which cancer a patient is being treated for within the model.
Once patients are assigned to a specific cancer type within the model, that attribution drives how their care is benchmarked financially and how outcomes are evaluated within their cancer cohort. Ultimately, it has a significant impact on performance measurement.
know there is an increasing number of patients in oncology who have concurrent cancers. This creates an opportunity for misalignment between the cancer type to which a patient is attributed within a value-based care model and the cancer for which they are actually receiving treatment.
Our abstract examined different approaches to identifying a patient’s cancer type. The central question we pose is whether clinical data should be incorporated into the methodology used to reconcile cancer attribution within value-based care models. Rather than relying solely on administrative claims, we believe there may be value in examining treatment indications and other clinical information to ensure a more accurate understanding of the patient’s diagnosis and its true impact on costs and care.
What do the findings reveal about the challenges of accurately attributing cancer type in patients receiving oral therapies?
Hellmann: At a high level, the findings highlight an opportunity to rethink how we assign patients, particularly in the oral oncolytic space.
For this analysis, we used claims data available through The US Oncology Network and attempted to link those claims to patients’ diagnoses within the electronic health record (EHR) using static data points.
We found that concordance was very high for infusion-based therapies. However, we observed a lower concordance rate for oral oncolytic therapies.
We know that oral oncolytics are becoming increasingly common. As that population grows, along with the population of patients who have concurrent cancers, we believe there is a meaningful opportunity to incorporate treatment indication information into value-based care methodologies. Doing so may improve the accuracy of cancer attribution and provide a more complete clinical picture.
How might the growing use of oral cancer treatments affect the accuracy of attribution in value-based oncology models?
Hellmann: We observed a significant gap in our ability to link oral oncolytic therapies with corresponding data in the EHR.That does not mean the information was absent from the EHR. Rather, it suggests that the information was not located in the specific data fields we were examining.
I think this raises 2 important opportunities. First, we need to ensure that clinicians have the ability to document information in locations where it can be readily retrieved and analyzed. Second, it suggests that value-based care models may need to consider whether administrative data alone remain sufficient as oral therapies become more prevalent.
As we move into a broader oral oncology landscape, we may need to consider a more comprehensive clinical picture when determining cancer attribution.
What changes could help improve cancer attribution and accountability in future value-based care programs?
Hellmann: That is really the central question posed by the abstract.
What we are asking is whether treatment indication information can be incorporated into attribution methodologies and reconciled with what evaluation and management claims data are telling us.
When there is a mismatch between those sources, could we look more closely at the underlying claims data to determine whether a concurrent cancer diagnosis exists or whether another factor explains the discrepancy?
Doing so would benefit both model participants and model sponsors by providing a clearer and more accurate picture of performance, patient experience, and the overall impact of the model on patient care.
What is the key message you aimed to convey to the ASCO audience during your session, and what takeaway do you hope they gained from it?
Hellmann: The main takeaway is that cancer care continues to evolve, and the way we treat patients continues to evolve as well.
That evolution creates an important opportunity to revisit attribution methodologies and modernize them in the same way. By doing so, we can better capture the full clinical picture of our patients and ensure that value-based care models accurately reflect the care being delivered.
Ultimately, the goal is to align attribution methods with the realities of contemporary oncology practice.
Reference
Liu H, Hellmann J. Rethinking cancer attribution in oncology VBC models: E&M vs treatment-based approach. J Clin Oncol. 2026;44(suppl 16):1580. Presented at: 2026 American Society of Clinical Oncology Annual Meeting; May 29-June 2, 2026; Chicago, IL.
