Nina Chavez Emphasizes the Impact of High Drug Costs in Value-Based Models

Nina Chavez, MBA, FACMPE, chief operating officer, New Mexico Oncology Hematology Consultants, Ltd., explains how high-cost therapies create a challenge for practices to succeed under value-based care models like the Oncology Care Model (OCM).

Transcript

With more high-cost therapies on the market, is it a challenge for practices to succeed under value-based models, which look at the total cost of care?

Yes, definitely. That’s one of the major concerns that we have from an oncology perspective, is that we can only control what we can control. The price of the drug we can’t control. We can’t control inpatient stays or anything that’s not related to oncology. With the OCM, sometimes, if the patient goes in for a hip replacement, if the patient has a heart attack, you get that. There’s parts that come in and out; there’s the level of scale and some other things that they’re doing, but you get the total cost of care, which doesn’t always include only oncology.

So, we’ve really been looking at models, and I know there’s a lot of models out there with [Community Oncology Alliance] and even with the [Making Accountable Sustainable Oncology Networks] through the [Physician-focused Payment Model Technical Advisory Committee] that says let’s take the cost of drugs out of it. Let’s look a way so that we’re not responsible for things we can’t control. Let’s emphasize the things we can control—the patients calling in and keeping them out of the [emergency department] and having urgent care visits and same-day visits, and managing the patient symptoms and their treatment so that they don’t end up in the [emergency department], so they don’t end up in the inpatient unit unless they absolutely need to be there.

Some of them need to be there. There are those cases where the patient should be in the hospital, and we need to not keep them out of the hospital because we’re worried about cost.