Value-Based Care

In the face of escalating costs of cancer drugs, the American Society of Clinical Oncology (ASCO) rightly asks, what is the value of these new medicines?

Rising to a level of equal status with cancer providers is a tall order for patients with cancer, yet it is precisely the intent of the Meaningful Use Stage 3 proposed standards that are set to take effect in 2018 (ie, patient-reported outcomes), as well as the value-based care initiatives. Providers need to drop their resistance and contemplate the following benefits of patient centricity.

The American Society of Clinical Oncology (ASCO) new value framework abandons the Hippocratic Oath. No longer is the doctor’s first obligation to “apply, for the benefit of the sick, all measures which are required.” Instead, ASCO’s value framework has the potential to help insurers “evaluate the relative value of new treatments” as they develop “benefit structures, adjustment of insurance premiums, and implementation of clinical pathways and administrative controls."

Significant gains in cancer research and prevention have led to longer survival, improved quality of life, and decreased disease burden. The 2015 annual report on “Clinical Cancer Advances” from the American Society of Clinical Oncology (ASCO) outlines the biggest advances made in oncology, and for the first time designates one cancer as the Advance of the Year, as well as emphasizing the ongoing challenge of value-based care.

Hollywood, FL—Value-based decision-making at the bedside can be fraught with obstacles, with no clear agreement on what constitutes value, and for whom. In addition, the myriad insurance plans preclude uniform treatment strategies, despite clinical pathways and guidelines intended to reduce variation in care. Finally, value is becoming more difficult to achieve in oncology as each benefit becomes more expensive, with the cost of new therapies outpacing inflation.

The Merriam-Webster dictionary defines “logistics” as the things that must be done to plan and organize a complicated activity that involves many people. The modern delivery of cancer care precisely parallels this definition.

Chicago, IL—Oncologists should become value-based providers by eliminating unnecessary tests, prescribing cheaper alternatives when therapeutic equivalents exist, and keep calling for payment reform, said Ezekiel J. Emanuel, MD, PhD, Chair, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, at the 2014 American Society of Clinical Oncology meeting, during a session on defining value from different stakeholder perspectives.

The addition of lapatinib (Tykerb) to trastuzumab (Herceptin) to create dual HER2 blockade was no better than trastuzumab alone in the adjuvant treatment of patients with HER2 breast cancer in the global phase 3 ALTTO (Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation) trial, reported Martine J. Piccart-Gebhart, MD, PhD, Chair, Breast International Group, Brussels, Belgium, at a plenary session at the 2014 American Society of Clinical Oncology (ASCO) meeting.

Blue Cross Blue Shield (BCBS) is implementing value-based care and payment models across the country to reward quality and improve outcomes, and these are amounting to billions of dollars in cost-savings and reduced hospitalizations.