Delivering High-Quality Care Under Value-Based Payment Models: Where Are We Now?

As the term “value” has become a norm in healthcare, specifically in oncology, panelists at a National Comprehensive Cancer Network policy summit offered perspectives on where we are now in delivering high-quality cancer care under value-based payment models.

The panelists all agreed on a common barrier: defining value. It’s no surprise that different stakeholders hold different definitions of what value is, but which views should be taken into consideration?

There’s also the question of how to measure value. Currently, value-based initiatives don’t measure value directly, said John O’Shea, MD, senior fellow, Center for Health Policy Studies, The Heritage Foundation. Instead, cost and quality measures are combined together.

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“There’s a desire to wait for the perfect measure, but we may not ever get that perfect measure,” said Robert S. Saunders, PhD, researcher director, payment and delivery reform, Duke-Margolis Center for Health Policy. “So, what do we do with the measures we have today?”

Panelists Andrea Ferris, MBA, president and chief executive officer, LUNGevity; Lee Newcomer, MD, MHA, Lee N. Newcomer Consulting; and Christian Downs, MHA, JD, executive director, Association of Community Cancer Centers, argued that payment models need to have broader scopes that look at the total cost of care, not just the drug price. They should take into account factors such as how often a patient comes in for the administration of the drug, drug toxicity, frequency of scans, and support services.

Looking specifically at the Oncology Care Model (OCM), current challenges may not be with the model itself or its incentives, but rather the infrastructure needed for the model, said Saunders. Community practices often struggle with the upfront costs of implementing the services they need to succeed, such as 24/7 access and call centers.

Most panelists agreed that despite some evidence of benefit stemming from the OCM, it’s still too early to deliberate on its efficacy. It’s hard to determine if there’s value because the model tends to focus on spending reduction, with no weight given to patient-reported outcomes, said O’Shea.

However, despite being early into the model, there have been some notable benefits. “OCM has been a good thing to push us as providers to sit at the table and think, constructively, about how we deliver care,” said Warren Smedley, MSHA, MSHQS, service line director, cancer, University of Alabama at Birmingham Health System. Drug spending aside, practices have been able to make positive changes, specifically with care coordination, which has a significant impact on patient care.

Downs agreed, saying that if practices can effectively implement care coordination, patients, insurers, and providers will all reap benefits.

Discussing how new, innovative, and often very costly therapies fit into these payment models, Newcomer posed the question, “When can you say this is now an acceptable technology for all of the United States and not just trial populations, and how do you put a reasonable regulator on where the technology expands?” He added, “When you put a technology out in the field, it has a very narrow indication and the next step is people want to try it on a cousin of that [indication].”

For these therapies, there needs to be a framework for gathering evidence on where the therapy works and where it doesn’t, and where it does work should be the standard of care, said Newcomer.