The Lynx Group

Value-Based Care

In October, the National Comprehensive Cancer Network (NCCN) released its first set of “flash cards” or “Evidence Blocks” as a tool for evaluating treatment decisions, seeking to solve a drug cost problem that does not exist, by adding to a problem that does: insurers shifting the cost of cancer treatment to patients. In so doing, the NCCN could inadvertently increase the rate at which patients with cancer choose assisted suicide.
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The Triple Aim of better patient care, lower spending by payers, and the maintenance of financially viable practices and hospitals is achievable with condition-based payment models in oncology, said Harold D. Miller, MS, President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform, at the Fifth Annual Conference of the Association for Value-­Based Cancer Care.
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As patients, providers, payers, and policymakers continue to seek ways to assess the value of cancer therapies by balancing clinical benefits and treatment costs, a number of tools have been released to define the value of medicines.
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At the Fifth Annual Conference of the Association for Value-­Based Cancer Care in Washington, DC, Grant Lawless, RPh, MD, FACP, of the University of Southern California, Los Angeles, moderated a multidisciplinary panel on value-based care for patients with multiple myeloma.
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Although we all admire and support the efforts put forth by many experts to help quantify the “real” value of cancer medications, they still miss the mark in 2 dramatic ways.
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How can cancer care decisions be based on value? Two champions are starting to add science to this controversial discussion, which will eventually help all stakeholders make more informed decisions.
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Medicare’s Oncology Care Model (OCM) proposes a partial shift in financial risk from Medicare to oncologists. This incentivizes oncologists to use higher-­value, lower-cost services. Information such as the recently released American Society of Clinical Oncology (ASCO) framework to assess new cancer treatment options will likely garner keen interest among providers participating in the OCM or similar programs, to the benefit of providers, payers, and patients.
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The American Society of Clinical Oncology (ASCO) value framework essentially calls for accountability and transparency, which are qualities that are beneficial to providing complete care for patients and to improving positive patient outcomes.
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The emergence of various tools for assessing value or, more to the point, drug costs—both direct and indirect—by leaders within the oncology and hematology community is highly commendable. Those of us on the managed care side of healthcare look forward to practical and meaningful tools in helping patients, pro­viders, employers, and health plans navigate through the complexity of oncology drug therapy and drive better informed decision-making.
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Value-based oncology was one of the high-profile topics at the 2015 American Society of Clinical Oncology (ASCO) meeting. It is something that is discussed widely in print and on social media. It is certainly top of mind for payers, doctors, policymakers, business leaders, and, in particular, patients.
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