Value-Based Care

A new payment and delivery model introduced by the Center for Medicare & Medicaid Innovation aims to align financial incentives to improve oncology care and outcomes. Expected to begin in July 2016, the program will target patients from the start of their chemotherapy through 6 months of care.

Society meetings, such as the recent American Society of Hematology (ASH) annual meeting, generate a lot of clinical-related excitement regarding new treatment options, protocols, and pathways for hematologic cancers.

Medicare has initiated several programs in the past decade to encourage value, but questions remain regarding their effectiveness. At ASH 2015, Andrew Ryan, PhD, MA, Associate Professor of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, addressed the implications of using financial incentives to drive care quality and reduce cost.

Washington, DC-An evolving knowledge of cancer biology and the availability of comprehensive genetic testing engender a need for tools that help oncologists integrate these data and select therapy, said Gary Palmer, MD, Chief Medical Officer, NantHealth, Los Angeles, CA, in delivering his keynote address at the Fifth Annual Conference of the Association for Value-Based Cancer Care.

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.

“Centers of Excellence” (COEs) is not a new concept in healthcare. The underlying hypothesis is that providers who specialize in a particular procedure or service will produce superior, predictable outcomes. Payers have developed COE networks to manage cost and quality for complex medical conditions for more than 2 decades, steering volume to high-performing providers in exchange for discounted contractual rates. Under significant pressure to reduce the burden of cancer spending, payers are beginning to make bold network decisions, including narrowing networks, but they need precision tools to ensure that quality of care is uncompromised, and even improved, while reining in unsustainable cost trends.

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.

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.

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.

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.