- Center on Health Equity & Access
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- Value-Based Care
Appropriate, Value-Based Care in Immuno-Oncology
The idea of cost of care should be simple, but buying healthcare is incredibly complex, states Andrew L. Pecora, MD. Most individuals do not think about the potential for developing cancer when they make healthcare-related decisions.
Payers have to consider premium costs and risk pools, and generally have to look at their actuarial budgets over 3 to 5 years. In order to make actuarially sound reimbursement decisions, it is important to look at the total cost of care. If a drug is expensive, but changes the natural course of the disease, it provides value, explains Pecora.
There are ways for oncologists to assist patients in getting appropriate coverage for their prescribed regimen. For patients with limited insurance coverage, there are patient-assistance programs. It is important for oncology practices to communicate with payers about their treatment decisions in advance and to ensure these entities that the care is appropriate.
Balancing Cost and Quality in Oncology: A Value-Based Care Perspective
January 30th 2025Travis Brewer, vice president of payer and public health strategy/relations at Texas Oncology, shared that value-based oncology care can achieve both cost efficiency and high-quality outcomes through integrated multidisciplinary teams, flexible payment models, and targeted treatment approaches.
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Unlocking Access: Exploring Mental Health Care Among Medicaid Managed Care Enrollees
January 23rd 2025On this episode of Managed Care Cast, we speak with the author of a study published in the January 2025 issue of The American Journal of Managed Care® to examine the association between quantitative network adequacy standards and mental health care access among adult Medicaid enrollees.
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