IVBM All Coverage

When deciding which treatments to cover, states and commercial payers must wrestle with opportunity costs as new therapeutics come to market. A panel at Virtual ISPOR 2020 discussed some of the factors that go into those decisions.

New technologies and quick drug approvals contribute to the challenges of incorporating value-based care in oncology, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Two of the panelists appearing during the Virtual ISPOR 2020 meeting preview what's needed in improving value assessment: Lou Garrison, PhD, of the University of Washington, and Leah Howard, JD, of the National Psoriasis Foundation.

We spoke with Dr Mark Fendrick, co-editor-in-chief of The American Journal of Managed Care®, and director of the University of Michigan Center for Value-Based Insurance Design, or V-BID, on how the principles of V-BID can be used to make a real difference for the millions of American families financially struggling with the impacts of coronavirus disease 2019 (COVID-19) and can help shape the new healthcare delivery landscape after the pandemic.

Oncology practices in 2-sided risk arrangements have reported mixed results, pointing to the need for more time to make the transition, said Michael Diaz, MD, president of Community Oncology Alliance.

Individuals should register for Community Oncology Alliance's virtual meeting to hear "amazing" speakers present groundbreaking research, said Lalan Wilfong, MD, medical oncologist and vice president of value-based care and quality programs at Texas Oncology.

The expansion of Medicare Advantage benefits patients, but presents challenges in oncology care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.

Networking with other practices, sharing ideas, and getting physicians involved in the process can aid community practices moving to alternative payment models (APMs), said Michael Diaz, MD, president of Community Oncology Alliance.

“Quest for Value: Advancing Oncology Value-based Care,” this year’s first installment in the Institute for Value-Based Medicine (IVBM) from The American Journal of Managed Care®, zeroed in seniors, a population that’s growing not just in Florida but across the United States. Older Americans are more likely to develop cancer, but thanks to better detection and treatment, they are more likely to survive cancer, too.

Part of the reason COA recommended a 'ramp up' period is we need time for the vendors to understand what they need to be incorporating in their software, said Michael Diaz, MD, president of Community Oncology Alliance.

"I am not convinced yet that the Oncology Care First Model truly takes into account necessary elements, including high-cost drugs," said Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists.

"There is this mentality that hospice means the patient is going to die very soon, and that's really not true," said Maen Hussein, MD, physician director of finance at Florida Cancer Specialists.

Sharing records and encouraging conversation will promote better collaboration between primary care and cancer care, said Jeffrey Lowenkron, MD, chief medical officer of The Villages Health.

"We want to make sure practices have time to learn, understand, adapt, and modify, to a new Oncology Care Model," said Michael Diaz, MD, president of Community Oncology Alliance.

Educating primary care providers and patients on accessible lung cancer screenings can help reduce lung cancer mortality, said Maen Hussein, MD, physician director of finance at Florida Cancer Specialists.

There has been significant improvement in payers' understanding of site of care issues, but steps still need to be taken to address these issues, said Lucio Gordan, MD, president and managing physician at Florida Cancer Specialists.

Coverage from the Institute for Value-Based Medicine® session held in Nashville, Tennessee.

In today’s Managed Care Cast, we bring you portions of the panel discussion during the the last Institute for Value-Based Medicine® (IVBM®) event for 2019, where oncologists and others shared their thoughts, successes, and frustrations with the current Oncology Care Model, as well as the question and answer session.

Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer at Independence Blue Cross, discusses key features that payers should include when implementing a value-based agreement.

Accountable care organizations (ACOs) have saved Medicare a total of $3.53 billion from 2013 to 2017, or $755 million after shared savings were paid out, according to a new report from the National Association of ACOs (NAACOS).

Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer at Independence Blue Cross, discusses the role of data exchange and analytics in value-based agreements.

Population health management and coordination of care are integral to value-based contracting, explained Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer at Independence Blue Cross.

Value needs to be considered early in the development life cycle of a therapy and should be continued throughout, even into the postlaunch space using real-world studies, according to a presentation on value-based services and their life cycles at the AMCP Nexus 2019 meeting.

Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer at Independence Blue Cross, explains how value-based agreements can benefit providers, patients, and payers.

Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer at Independence Blue Cross, discusses how the increasing share of novel, costly therapies will impact the prevalence of value-based agreements.

The main thing that the Oncology Care Model (OCM) has brought is a shift in the mindset, said Terrill Jordan, chief executive officer of Regional Cancer Care Associates.

In a long-awaited move, HHS announced Tuesday plans to reform federal antikickback statutes and overhaul the so-called Stark Law, which was originally intended as a safeguard against financial incentives that would inappropriately influence physicians’ clinical decisions, in an effort to speed the transition to value-based care.

Lawrence N. Shulman, MD, director of the Center for Global Cancer Medicine at the Abramson Cancer Center, and professor of Medicine at the Hospital of the University of Pennsylvania, explains how providers are reacting to more effective, more costly therapies entering the cancer landscape.

Terrill Jordan, chief executive officer of Regional Cancer Care Associates, discusses Oncology Care Model performance period 4 results and the biggest challenges community oncologists continue to face when trying to perform under the model.

During a panel discussion on defining, standardizing, and reporting quality in cancer care during the National Comprehensive Cancer Network Policy Summit held September 12 in Washington, DC, it became clear that stakeholders of all backgrounds have set their focus on one type of metric in particular: patient-reported outcomes.