Stakeholders Define Value in Healthcare

Bruce A. Feinberg, DO: Hello everyone, and thank you for joining us at the American Journal of Managed Care’s Oncology Stakeholders Summit. This is the Spring 2016 Peer Exchange Video Program. This program, which focuses on value-based care in oncology, will include a roundtable discussion, as well as a series of individual interviews featuring a distinguished group of healthcare experts with varied backgrounds in managed care, community oncology, and policy. My name is Dr Bruce Feinberg, and I am vice president of clinical affairs and the chief medical officer at Cardinal Health Specialty Solutions.

I am joined today by Dr Alan Balch, chief executive officer for the National Patient Advocate Foundation in Hampton, Virginia; Mr James Gilroy, senior director of market access and national accounts at Lilly Oncology; Dr Ira Klein, senior director of health care quality strategy in the Strategic Customer Group of Janssen Pharmaceuticals; Dr Michael Kolodziej, national medical director for oncology strategy at Aetna; and Mr Ted Okon, executive director of the Community Oncology Alliance. Thank you, again, for joining us.

Value-based care, by definition, incorporates cost into clinical decision making. Robust debate continues as to what constitutes cost, who’s responsible for managing cost, and how cost should be communicated. Today’s discussion will illustrate the complexities and hurrying to assessing costs as our healthcare system migrates to value-based care. We’ll be covering a few important topics: evolution of value-based care, what should be incorporated in value-based care, and how should value be calculated.

Let’s start this off. I think I’m going to start with Ira because Ira has sat on both sides of the fence now that he’s working for a pharmaceutical company and lived for many years in a payer world. When you think about value, what’s the definition that resonates with you?

Ira Klein, MD, MBA, FACP: I would say that previously, I had always said that value is the outcomes generated over the cost incurred. And over time, what I’ve come to realize is that the outcomes generated is actually not a single answer. It’s value over a continuum—or, I should say, outcomes over a continuum.

The outcomes differ depending on who you are. If you’re the payer of services, you want to see that cost of a therapeutic be applied, and you also want to see the total cost of care be affected by the therapeutic. If you’re a patient, you want to be sure that you’re getting what you want for a disease. A lot of this will focus on oncology. What do patients want? They want cure. If cure’s not possible, they want amelioration of disease, and they always want to have minimal side effects, ease of use, and some kind of assurance that they’ll be able to participate in, if not the same lifestyle as before, something close to that previous lifestyle. So, I’ve kind of evolved over time to thinking about outcomes as a continuum.

Bruce A. Feinberg, DO: All right. So I’m concerned, from the patient perspective, that although I think it’s really important in terms of what Ira brought out, for somebody who is living in the world of the patient, I’m not sure that’s the complete picture of what patients are looking for and if they’re really able to understand the process well enough that they can assess value in a meaningful way.

Alan Balch, PhD: Yeah. I think, first of all, it’s important to keep in mind that the system, as it’s currently constructed, was not inherently designed for the patient to be an active consumer and decision maker in the process. Therefore, value through that consumer and patient lens isn’t really ingrained into the current framework.

I think this is an exciting opportunity from a patient perspective. As we talk about shifting from volume to value, the increasing role of consumer-driven healthcare designs, and the shift in responsibility for payment shifts to patients, as well as the personalized medicine paradigms that are coming to fruition, there is an exciting opportunity for patients to be much more involved in this process of what is [considered] value. I think the rub, from a patient perspective, is that we think of value at the individual level, and it really varies from person to person.