Eliminating Low-Value Services Can Improve Access to Innovative Cancer Treatments

There have been amazing innovations and advancements in cancer care, but lately much of the focus on value-based care has revolved around costs and lower spending instead of health improvements, said A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design, professor of internal medicine, and professor of health management and policy at the University of Michigan.

Fendrick, the co–editor in chief of The American Journal of Manage Care^®, attended the annual Patient-Centered Oncology Care^® meeting to announce the recipient of this year’s Seema S. Sonnad Emerging Leader in Managed Care Research Award.

While he said many of the value-based care programs, such as utilization management, health plan benefit designs, and even Medicare drug price negotiation, are well meaning, the goal is often to lower spending.

“I didn't go to [medical] school to learn how to save people money. I went to medical school to learn how to make individuals and populations healthier,” Fendrick said. “So how we could fix this? I think while people are lamenting about costs [of] these expensive, but incredibly high-value cancer diagnostics and treatment,…everyone agrees there's enough money in the system, and I think if we would all come together and buy more of the good stuff and less of the bad stuff, we wouldn't be in the conundrum that we're in.”

He stressed the importance of measuring and eliminating services that do not improve patient health or even cause harm in order to free up funds for innovative cancer treatments.

Fendrick also discussed the financial toxicity patients face for care, which makes it difficult for them to pay rent, buy gas, or afford healthy food. He added that while the Affordable Care Act eliminated the cost for the initial screening for breast, cervical, lung, and colorectal cancers, patients who test positive have high out-of-pocket costs.

“It's bad enough emotionally to know that you may have cancer. The fact that you may not be able to pay to find out whether you have cancer or not is something [oncologists] must address,” he said, urging oncology stakeholders to get behind the movement to ensure follow-up diagnostic tests for screenable cancers are easy for patients to access.