Dr Robert Navarro Foresees Unintended Consequences From Shift to Value-Based Care

We have to decide if we’re prepared to not cover low-value treatments as we shift to value-based care, said Robert Navarro, PharmD, clinical professor, College of Pharmacy, University of Florida.

Transcript

Are there any unintended consequences that comes from the shift toward value-based care?

There unintended consequences and hazards of pursuing value-based care, and I certainly support that. Whenever I purchase something, I certainly try to obtain value. However, in my decision, or anybody’s definition of value, that means there are some high-value services—drugs, devices—but also some low value. We have to decide if we’re prepared to not cover low-value treatments. Now, we have heard that about 30% of healthcare is waste, low-value care. I think, without question, we would all agree that we should not pay for low-value services.

Now, the providers or hospitals that are providing that care may have a different opinion in terms of our assessment of value. However, I think it’s very clear. However, with pharmaceuticals, we have to consider the fact that we will not be covering as many drugs as we have now. If we compare ourselves to other countries, the number of oncology drugs that are covered, for example, in the UK by the National Health Service is about half of what we cover in the US. Now, I have that from somebody that was on the National Institute for Health and Care Excellence oncology committee, and he often recommended for patients to go to the US if they want coverage of certain low-value oncology drugs that are not available in the UK.

Now, we have to decide if we’re okay with that as a society and as patients. I think that will be very difficult to do, and we may require some congressional action that may make CMS the leader in not including all oncology drugs on the Medicare Formulary Reference File for example.

I think that pursuit of value in the US is a bell that we cannot unring. This is the next big thing; we’re all proceeding toward value. I think that when we actually execute value, on a healthcare system basis, or certainly on a societal basis, there will be some very difficult decisions to make on what we don’t cover. There’s also a major discussion in terms of the role of the patient. That is, should value-based care surround what the patient wants. Are the patients in the best position to determine what is value-based care? The different view of stakeholders in the definition of value is something that as a society we’ll have to determine.