Payers’ Perspectives on Cancer Care

Conference Correspondent

In an environment of increasing vertical and horizontal integration in healthcare, are new value-based care models in oncology—such as CMS’s pilot Oncology Care Model (OCM)—working? Five years from now, will we still be talking about efforts to go from volume to value using alternative payment models? These were some of the key questions posed to leading representatives from payer groups of all sizes, ranging from the biggest national payers to regional health plans, during the October 20 session of the Association for Value-Based Cancer Care (AVBCC) 10th Annual Summit.

Many of the participants in the lively discussion, moderated by Michael Kolodziej, MD, Vice President and Chief Innovation Officer with ADVI, agreed that OCM, which currently involves approximately 25% of US oncology practices, is probably not scalable beyond the regional level.

“I think we need a solution for America, not the best 25% of practices,” Dr Kolodziej said.

“The concept of value-based care still has a pulse in oncology, but it needs to be parsed out into engagement with large volumes of patients,” said Roger Brito, DO, Division Head of Enterprise Oncology at CVS Health Aetna.

Other hot topics included whether to eliminate buy and bill; shifting value-based models from managing hospital and emergency department admissions to the major driver of oncology spend—drug costs; and the high cost of end-of-life care and the paucity of evidence driving later lines of cancer therapy.

“The game needs to change,” said Dr Brito. “The guidelines are pretty clear for early-stage therapy and usually involve the same regimens. In late-line therapies and very advanced cancers, quite frankly, we need to do better. That’s where there’s a real opportunity to have discussions about palliative care and to improve on care delivery in the United States.”

It is not too late to register for the AVBCC Summit! With more than 40 webcasts and other sessions, the 10-week agenda is packed with timely insights and no-holds-barred debates that you need to understand today’s cancer care ecosystem and trends for the future.

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