Value-Based Care

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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With all the focus in the media on cancer drug costs, let alone within the oncology community, the American Society of Clinical Oncology (ASCO) has released its much-anticipated value framework.
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Value versus cost is becoming an increasingly common question, particularly when evaluating new cancer drugs. The American Society of Clinical Oncology recently published its initial value framework to assist in assessing the value of new cancer therapies.
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The high costs of specialty medications and the burden they place on individual patients and on the healthcare system overall are the media topics du jour. Cancer drugs are often cited as examples of unrestrained medication costs, so it is not surprising that the oncology community has responded by proposing alternative pricing models for cancer treatments based on the incremental value they provide.
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The American Society of Clinical Oncology (ASCO) value framework and Memorial Sloan Kettering Cancer Center (MSKCC)’s DrugAbacus are 2 recent examples of an increasing trend of value-­based modeling to assess pharmaceuticals. Of particular interest, these methodologies represent some of the first efforts to incorporate a systematic approach to value specific to oncology. Xcenda, an AmerisourceBergen company, has previously reported on the increasing shift to value-based care with the Department of Health & Human Services and select large US payers.1 Outside of the United States, single-payer systems in Europe have taken an even more aggressive approach to value-based models, going as far as to quantify the value of human life, and then to measure the use of a drug versus its ability to prolong life in a demonstrable way.
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