Interviews

By 2020, more plans will incorporate value-based insurance design (VBID) principles as a way to lower cost sharing for high-value services and potentially increase cost sharing for low-value services, according to Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School.

The idea of risk sharing within value-based care is a wonderful concept, but it has not yet changed behavior and outcomes to the extent one would hope, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center. A potential reason is the variation in metrics and incentives used within different systems.

In a convenient care setting, collaboration is key to providing comprehensive care and thorough information to patients whether they have a primary care physician or not, said Kristene Diggins, FAANP, CNE, NEA‐BC, DNP, MBA, manager of professional practice at MinuteClinic.

The criteria to enroll cancer patients in a clinical trial of CAR-T cells vary according to their disease, past therapy, and how far along they are in different treatments, said David L. Porter, MD, of the University of Pennsylvania Health System.

Patient-centered medical homes are valuable because they allow insurers to look at the cost of all of the patient’s treatments, services, and physicians throughout the continuum of care, explained Kim Eason, manager at Horizon Blue Cross Blue Shield of NJ.

Patients need help shaking off the negative stigma associated with obesity and improving their self-worth before they can start to work with clinicians on treating the disease process, said Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital.

Technological advances in cancer care have changed the very process of treatment, as now oncologists can gain more insight into the most effective therapy for each individual patient, according to Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology.

Aetna has developed a number of initiatives and partnerships to help address the social determinants of health for needy patients outside of the clinical setting, according to Harold L. Paz, MD, MS, executive vice president and chief medical officer at Aetna.

The most transformative software companies are those that have seized the opportunity to incorporate clinician and patient voices into the design of their health IT tools, according to Carrie Stricker, PhD, RN, AOCN, chief clinical officer and co-founder of Carevive.

Patients are becoming more engaged in their own healthcare, meaning they have more input in the quality measurement process and can even help develop quality measures for the future, said Eleanor Perfetto, PhD, senior vice president of strategic initiatives for the National Health Council.

Researchers implementing the TAPUR trial have encountered some difficulties, particularly in filling the study cohorts, said Pam Mangat, MS, associate director TAPUR study at the American Society of Clinical Oncology (ASCO). However, the ASCO team is dedicated to forging ahead and addressing those challenges.

The traditional care team model places doctors in charge of the team, but this structure may not be the most effective for complex patients with social challenges and other issues, said Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers.

The Information Exchange and Data Transformation initiative at the FDA uses oncology data from not only clinical trials but also electronic health records and biosensors. This patient-centered approach brings research to the real world, as many oncology patients are excluded from clinical trials, said Sean Khozin, MD, MPH, senior medical officer at the FDA.

Underinsurance, which occurs when people have insurance but aren't covered for services they need, is a serious problem in the US, according to A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan. He proposed some strategies to alleviate this phenomenon, like smarter deductibles and revised Internal Revenue Service (IRS) rules.

The state of current software systems, primarily electronic medical records, is a significant barrier to implementing successful health IT tools, said Jonathan Hirsch, founder and president of Syapse. He also explained some of the solutions developed by Syapse to address these challenges, like improving the software’s integration capabilities and making it more usable for providers.

As the shift from volume-based care to value-based care continues, providers will require a whole new mindset and skillset to be successful, according to Katherine Schneider, MD, president of the Delaware Valley ACO.

Data from electronic health records aren’t always helpful for oncologists, which is why the founders of Cancer Outcomes Tracking and Analysis (COTA) developed a platform that stratifies patients by relevant characteristics, said Stuart Goldberg, MD, chief medical officer, COTA, John Theurer Cancer Center.

Physicians may have a hard time relinquishing their own piece of the healthcare puzzle, whether due to financial incentives or inadequate care coordination, said Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center.

Oncologists need to ask patients the right questions and truly listen to the answers, but they must then balance the individuals’ goals with the practice’s efforts to provide consistently efficient cancer care to all patients, according to Robert W. Carlson, MD, CEO of the National Comprehensive Cancer Network.

Bundled payment models could provide surgeons with a full spectrum of data that can help them decide which hospital is the right choice for their patients, said Andrei Gonzales, MD, McKesson's director of value-based reimbursement initiatives. He also said that this data can drive improvement for hospitals that may be falling behind.

Payers have been slow to adopt new technologies, but they are starting to be more proactive in seeking out genomic profiling companies, according to David Fabrizio, of Foundation Medicine, Inc. These molecular diagnostic tools make the healthcare process more efficient by performing a comprehensive test at the point of diagnosis.

Patients have a number of concerns about insulin, including pain from injections and interference with their activities, said Yehuda Handelsman, MD, FACP, FACE, FNLA, medical director and principal investigator at the Metabolic Institute of America. However, clinicians must play an important role in explaining to patients how recent advances have made insulin delivery simpler and more convenient.

A major goal of the Choosing Wisely campaign is to educate and empower both the clinician and patient communities, eventually reducing the overuse of resources, according to Daniel Wolfson, executive vice president and chief operating officer of the ABIM Foundation.

The transformation to value-based oncology care must be centered upon the priorities and needs of patients and their families, said Joseph Alvarnas, MD, of the City of Hope and editor-in-chief of Evidence-Based Oncology. This vision is starting to be incorporated in areas like the Oncology Care Model, which looks at patient-reported outcomes and experiences.

The biggest challenge in moving to value-based care is the mindset of providers accustomed to volume-based care, as they must work with payers to change the systems, said Susan Dentzer, president and CEO of The Network for Excellence in Health Innovation.

CMS understands that not all physicians will report quality measures under the Medicare Access and CHIP Reauthorization Act or join advanced alternative payment models, especially immediately, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS. However, there are efforts in place to make it as easy as possible for these providers, which will hopefully increase participation over time.

As Cancer & Hematology Centers of Western Michigan starts to participate in the Oncology Care Model (OCM), it has dedicated its resources to understanding the model and analyzing data, said Stuart Genschaw, executive director of the Cancer & Hematology Centers of Western Michigan. Throughout this process, however, the practice’s main focus is always on “providing great care” to its patients.

Cooperation and trust are key in getting partners to work well together as part of a coordinated care organization (CCO), said Christine Bernsten, senior manager of delivery systems transformation for Health Share of Oregon.

Physicians have shown great interest in understanding how to transition into value-based processes, especially with the new rules under the Medicare Access and CHIP Reauthorization Act (MACRA), said Roy Beveridge, MD, chief medical officer of Humana. While these transitions take time and effort, they eventually lead to physicians being reimbursed more for longer visit times and improved outcomes.

David L. Porter, MD, of the University of Pennsylvania Health System, explains why treating tumors with a combination of CAR-T cells and other immune-stimulating agents is a logical next step for investigators.