Transforming Cancer Care by Controlling Costs and Improving Outcomes

Craig Deligdish, MD

March 2013, Vol 4, No 3 - From the Editor

Value Based Cancer Care (VBCC) was first published in May 2010, and the first annual meeting of the Association of Value-Based Cancer Care took place in May 2011. During the past 3.5 years, this publication and its annual meeting have provided a forum for stakeholders to address important issues that impact the value proposition facing patients with cancer, providers, and payers in an open and challenging fashion. Both the annual meeting and VBCC have focused on a dialogue around strategies for optimizing value in cancer care delivery.

As I contemplate my role as Editor-in-Chief of VBCC, I plan to enlist the expertise of the journal’s editorial board and others to continue to address innovative trends that enhance value-based care and examine the impact of diagnostic modalities, new therapies, and other initiatives that alter the value proposition, while improving outcomes and influencing how we think about cancer care.

In the past 30 years, patients and providers have witnessed and experienced a transformation in cancer care. Today, cancer costs account for approximately 5% of US healthcare spending. As patients with cancer live longer, it is expected that they will consume an even larger proportion of US healthcare dollars. Today, annual direct costs for the treatment of cancer exceed $100 billion in the United States, with an annual burden of more than $200 billion. As technology and drug costs increase, the cost of cancer care is expected to continue its upward trend. This, coupled with efforts by public and private payers to reduce reimbursements for cancer care, makes it imperative that providers of care in this vulnerable population integrate cost-saving strategies while maintaining optimal quality of care. Almost everyone who understands these challenges agrees that the current trends are not sustainable.

It has only been relatively recently that the provider community and the public have begun to appreciate the impact of cost on cancer care. The concepts of evidence-based cancer care, value, quality, cost, and the value equation have been brought to the forefront as providers and payers experiment and re-explore payment methodologies that potentially reward those who are willing to bear risk or improve value. The effort and the cost of the infrastructure necessary to achieve these goals should not be underestimated. Although one of the driving factors in how payers and providers think about cancer care has been the increasing cost of care, more recently the debate that has resulted from the Affordable Care Act (ACA) has furthered the discussion about rationing and has taken the end-of-life care discussion to a new level. The increasing role of government-sponsored healthcare will no doubt alter the way patients and providers think about care. With the ACA in place, the impact of government-sponsored healthcare and the ACA on private health insurance will begin to influence how care is delivered.

The past several years have provided us with a preview of how the consolidation of providers into hospital-based networks can increase the cost of healthcare. Hospital mergers and physician-practice acquisitions have occurred at rates that have not been seen in years. The ultimate impact of these factors on quality, access, and cost for patients with cancer and on providers has yet to be realized. VBCC will be examining these changes on our country’s delivery system. The effect of commoditizing cancer care through the use of guidelines and pathways that standardize approaches to diagnosis and treatment will also be examined. We will continue to examine changes in delivery systems that provide a more patient-centered approach to enhance quality and accountability while altering physician and patient behavior. We will simultaneously attempt to measure the value of personalizing care by examining innovative approaches to diagnoses and treatments, with a focus on value for evidence-based and non–evidence-based modalities.

My goal as Editor-in-Chief will be to ensure that VBCC provides readers the resources that may help them to understand the value proposition around managing the cost of treatment while improving patient results and patient satisfaction in a rapidly evolving care continuum.