Dr Andrew L. Pecora Outlines Issues Oncologists Have With Value Frameworks

Oncologists are aware of the various value frameworks that have popped up recently, but they are still in the first phase and many oncologists have issues with the frameworks, said Andrew L. Pecora, MD, FACP, CPE, chief innovation officer professor and vice president of cancer services at the John Theurer Cancer Center.

Transcript

How important do you think value frameworks like the ones put out by the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the Institute for Clinical and Economic Review are in today’s world as we move towards value-based reimbursement? And do you think physicians, oncologists in particular are aware of the existence of these frameworks?

I think oncologists are aware of existence of value-based frameworks. And the problem I think most oncologists have with the current value-based frameworks is they are sort of indirect arbiters of value, value being clinical outcome divided by total cost of care. We’re still going to get to the point where we can measure direct variables, the direct outcomes that should go into value like overall survival, progression-free survival, time to best response, incidence and severity of toxicity.

When a patient has cancer and they come to a cancer doctor, they’re not thinking about value, they’re thinking about living, surviving, overcoming this thing that could prematurely end their life. And that’s a complex problem, too, because a part of the time it can be dealt with immediately with a surgical procedure and you’re done. Sometimes you need a surgical procedure or maybe you don’t, but you can get medicines that can cure you. And then many times, regardless of a surgical procedure, there’s nothing that can cure you but there’s things that can keep you alive longer. So those are all different scenarios where the value equation, the actual things we measure are different.

But in the context of everyone attempting to get to value, I think what I would call in the first phase, but this isn’t the final state. The final state of value will be more in line with how other industries look at value like Boeing, the airplane manufacturer or Apple, the software computer manufacturer. That’s where healthcare is going to ultimately wind up but we’re not there yet.