Economics & Value

Value-Based Care Management Medicare Program Changes for 2020 and Beyond

Joe Bailes, MD; Gena Cook

December 2019, Vol 10, No 6 - Online First, Value-Based Care

Medicare models for value-based care in oncology started with the Oncology Care Model (OCM), which was launched in July 2016 and will run until June 2021. Value-based care is here to stay, as the Centers for Medicare & Medicaid Services (CMS) continues to develop and test more value-based models and tools through the Center for Medicare & Medicaid Innovation. CMS recently released an informal Request for Information on a proposed Oncology Care First model to succeed the first OCM. Commercial payers and state governments are also introducing their own value-based agreements with community oncology practices, hospitals, and health systems. [ Read More ]

Delivering High-Value Personalized Interventions

Chase Doyle

October 2019, Vol 10, No 5 - Value-Based Care

San Diego, CA—As the treatment landscape in oncology changes on a seemingly daily basis, providers face increasingly complex decisions, and it is not just the myriad of therapies available: oncologists must balance drug efficacy and toxicity, clinical outcomes, and patient quality of life, all while providing value-based care. Enter clinical pathways, a multidisciplinary management tool used to guide evidence-­based care for subgroups of patients with predictable clinical courses. [ Read More ]

FDA Unveils Oncology-Specific “Project Facilitate,” Expanding Access to Investigational Cancer Drugs

Phoebe Starr

August 2019, Vol 10, No 4 | Payers’ Perspectives In Oncology: ASCO 2019 Highlights - Value-Based Care

Chicago, IL—At ASCO 2019, the FDA announced an oncology-specific pilot program for physicians and patients who are seeking access to investigational therapies. The expanded access pilot program is a concierge service, said Richard Pazdur, MD, Director, FDA’s Oncology Center of Excellence, who spoke at a press conference where the new program—Project Facilitate—was announced. [ Read More ]

Patient Navigators, Clinician Education Can Remove Barriers to Enrollment in Clinical Trials

Chase Doyle

August 2019, Vol 10, No 4 | Payers’ Perspectives In Oncology: ASCO 2019 Highlights - Value-Based Care

Chicago, IL—Fewer than 7% of adults with cancer and even fewer minority patients participate in clinical trials, which negatively affects the ability to determine the safety and efficacy of new and investigational therapies. At ASCO 2019, 2 experts discussed strategies to overcome the barriers to clinical trial participation and to help enroll more patients with cancer in them. [ Read More ]

Hospital Readmissions for Venous Thromboembolism a Substantial Cost in Patients with Cancer

Chase Doyle

January/February 2019, Vol 10, No 1 | Payers’ Perspectives In Oncology: ASH 2018 Highlights - Value-Based Care

San Diego, CA—Real-world data highlight the significant clinical and economic burden associated with venous thromboembolism (VTE) in patients with cancer. The data come from a study of 12,785 patients hospitalized with acute illnesses, of which 2002 patients had cancer. The results were presented at ASH 2018 and showed that 3.9% of patients with cancer experienced a VTE event requiring rehospitalization—the highest proportion of patients among the study population. Moreover, 28.2% of VTE-related readmissions occurred within the first 30 days of initial hospital discharge. [ Read More ]

Economic Implications of Inpatient versus Outpatient Autologous Transplant for Patients with Multiple Myeloma

Chase Doyle

January/February 2019, Vol 10, No 1 | Payers’ Perspectives In Oncology: ASH 2018 Highlights - Multiple Myeloma, Value-Based Care

San Diego, CA—Analysis of healthcare utilization among Medicare beneficiaries with multiple myeloma suggests that the setting of autologous hema­topoietic stem-cell transplantation (HSCT) has a significant impact on provider reimbursement and out-of-pocket expenses for patients, according to data presented at ASH 2018. [ Read More ]

Inpatient Costs for Children and Young Adults with Acute Lymphoblastic Leukemia Higher at Specialized Cancer Centers, but for a Good Reason?

Chase Doyle

January/February 2019, Vol 10, No 1 | Payers’ Perspectives In Oncology: ASH 2018 Highlights - Leukemia, Value-Based Care

San Diego, CA—For children and young adults diagnosed with acute lymphoblastic leukemia (ALL), receiving treatment at specialized cancer centers has been associated with improved outcomes versus nonspecialized centers, but this comes at an increased cost, according to data presented at ASH 2018. [ Read More ]

Do No Financial Harm: How to Improve Cost Transparency in Cancer Care

Chase Doyle

December 2018, Vol 9, No 4 - Value-Based Care

San Diego, CA—We’ve heard the figures before: the price of cancer drugs has risen by orders of magnitude per month over the past decades, deductibles have tripled in the past 6 years, and employer contribution to premiums has increased by nearly 300% over the past 15 years. In addition to cancer treatment becoming more expensive, insurance design and drug formularies have changed, resulting in a greater financial burden for patients. [ Read More ]