Value in Oncology

With $137 billion and growing spent on treatment in the US healthcare annually, cancer care delivery poses a significant challenge. At a special session at ASH 2015 on new payment models, Michael Kolodziej, MD, National Medical Director for Oncology Solutions at Aetna, discussed pathways and the medical home as transitional solutions to value in cancer care.

Patients with multiple myeloma are making significant lifestyle trade-offs to manage the cost of healthcare, according to findings from the Cancer Experience Registry presented at ASH 2015. Joanne S. Buzaglo, PhD, Senior Vice President, Research and Training, Cancer Support Community, Philadelphia, PA, discussed survey results of patients with multiple myeloma who are assuming more costs, including direct costs (ie, copays and prescriptions) and indirect costs (ie, transportation costs and loss of income), which is leading to financial distress.

Oral targeted therapies, such as ibrutinib (Imbruvica) and idelalisib (Zydelig), represent a major advance for patients with chronic lymphocytic leukemia (CLL) and have undoubtedly changed the treatment paradigm for this disease and the clinical outcomes.

“Centers of Excellence” (COEs) is not a new concept in healthcare. The underlying hypothesis is that providers who specialize in a particular procedure or service will produce superior, predictable outcomes. Payers have developed COE networks to manage cost and quality for complex medical conditions for more than 2 decades, steering volume to high-performing providers in exchange for discounted contractual rates. Under significant pressure to reduce the burden of cancer spending, payers are beginning to make bold network decisions, including narrowing networks, but they need precision tools to ensure that quality of care is uncompromised, and even improved, while reining in unsustainable cost trends.

The American Society of Clinical Oncology (ASCO) recently issued its framework to assess the value of cancer treatment options in response to the major challenge of escalating healthcare costs in the United States.

The definition of value by patients with cancer does not necessarily coincide with other definitions by other stakeholders.

Chicago, IL—A transition from reimbursement based on volume to reimbursement based on value has begun to emerge, said speakers at the 2015 American Society of Clinical Oncology meeting in a session on payment reform. The transition will be clumsy, with competing and potentially mutually exclusive incentives.

Chicago, IL—The rising costs of cancer drugs and medical services, along with increased copays and high deductibles for patients, are adding a serious financial hardship to patients diagnosed with cancer, according to Neal J. Meropol, MD, Associate Director, Clinical Programs, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH.

Chicago, IL—At the special session on value during the 2015 American Society of Clinical Oncology meeting, Jennifer Malin, MD, PhD, Staff Vice President for Clinical Strategy, Anthem, Thousand Oaks, CA, presented the payer perspective on value in cancer care. The role of the payer, Dr Malin said, is to balance different stakeholders’ values and needs at various time points.

Chicago, IL—The presidential keynote address at the 2015 American Society of Clinical Oncology meeting was presented by Michael E. Porter, PhD, MBA, Bishop William Lawrence University Professor, Harvard Business School, Boston, who started the value discussions a decade ago. A strong proponent of changing the healthcare system to focus on value, Dr Porter suggests that the fundamental purpose of healthcare is to deliver great outcomes with increasing efficiency, but achieving this goal requires more holistic thinking about delivery care as science.