IVBM All Coverage

Outcomes for patients with cancer are continuously improving, but the increasingly complex healthcare system, new payment and delivery models that place more risk on practices, and rising costs of therapies has made it difficult for independent oncology practices to thrive and survive. However, independent practices present an important part of cancer care, delivering care to patients who are not near large hospital-based systems at lower costs.

Triage pathways can transform practices and save practices and CMS money by keeping people out of the emergency department and hospital, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

An artificial intelligence system can digest what would take a person 29 hours to read in about 30 seconds, so everything is right in front of providers at the point of care, says Barry Russo, chief executive officer of The Center for Cancer and Blood Disorders.

Stephen Grubbs, MD, vice president of clinical affairs at the American Society of Clinical Oncology, explains what stakeholders can expect from the new updates to the Patient-Centered Oncology Payment (PCOP) model, as well as some key differences between PCOP and the Oncology Care Model.

Blase Polite, MD, associate professor of medicine and the executive director for accountable care at the University of Chicago, discusses why he chose to focus on the state of the Oncology Care Model at the April 25 meeting of the Institute for Value-Based Medicine.

At the American Medical Association headquarters Monday, HHS Secretary Alex Azar and CMS Administrator Seema Verma announced 5 new Medicare primary care payment models designed to eventually incentivize the entire healthcare system to transition to value-based care, particulary for patients with chronic conditions.

With all the regulatory changes that CMS and HHS are rolling out, community oncology practices are facing significant changes in how they take care of patients, said Barry Russo, chief executive officer of The Center for Cancer and Blood Disorders.

Using oncology care pathways and treatment pathways has helped practices use evidence-based data to facilitate them to be sure they are using the right drug for the right patient at the right time, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

For endocrinologists, a cardiologist, a diabetes educator, and a room full of fellow health workers, the cost of doing nothing—not just to treat diabetes, but also to prevent it— is what feeds into the exorbitant cost of the disease, according to presentations and a panel at the inaugural meeting of the Institute for Value Based Medicine (IVBM) in Diabetes, an initiative of The American Journal of Managed Care®.

Community oncology practices need to come together as much as possible in order to respond to changes in the market, have a common voice, and to share best practices and learn from each other, said Barry Russo, chief executive officer of The Center for Cancer and Blood Disorders.

As clinicians learn how to manage patients most efficiently under a value-based care of delivery, they need to identify patients and risk-stratify those patients, said Ray Page, DO, PhD, president and director of research at The Center for Cancer and Blood Disorders.

The revolution in cancer care isn’t just about the wave of life-saving therapies, or the role of genetics in pinpointing exactly who should get which drug and when. As Ray D. Page, DO, PhD, FACOI, tells it, change also means getting back to the basics, so that the relationship between doctor and patient drives care—not insurance companies or Medicare or rules from the FDA.

The concept of value is a well-known topic among health policy experts, the payer community, and policy makers, but patients do not necessarily have the same idea of what value means. When discussions about removing low-value care from the system to save money come up, patients might get the wrong idea of what is going on and why.

The Virginia Center for Health Innovation (VCHI) is receiving a $2.2 million grant from Arnold Ventures to launch a 3-year statewide pilot to reduce the use of low-value care in the state of Virginia.

Low-value care that offers no benefit to patients, or can actually cause more harm than good, is costly to patients and the healthcare system. While low-value services are being identified and measured, it has been more difficult to reduce the use of low-value care.

In a webinar presented by the Health Care Transformation Task Force, Hoangmai Pham, MD, MPH, of Anthem, and A. Mark Fendrick, MD, of the University of Michigan Center for Value-Based Insurance Design, highlighted how to steed the healthcare industry toward a more consumer-centered model based on value-based insurance design.

All providers, regardless of where they work have a role in the shift to value-based care, but independent physicians need to have a voice in the transition, said Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

As the first clinically integrated oncology network, the Quality Cancer Care Alliance (QCCA) brings together the best practices and shares knowledge on value-based care, said Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

The electronic medical record (EMR) can be burdensome but having a good value-based care team collecting data can help, said Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

Results from the first 2 performance periods of the Oncology Care Model (OCM) highlighted areas where Northwest Medical Specialties was doing well and areas it could improve, said Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

Implementing the Oncology Care Model required educating physicians and staff on a new way to do the work and why the changes were necessary under the new model, explained Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

A recap of the discussion at the Philadelphia meeting of the Institute for Value-Based Medicine®, an initiative of The American Journal of Managed Care®.

Years before the Oncology Care Model (OCM) was implemented, Northwest Medical Specialties started preparing by making changes to the personnel in the practice, explained Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

The practices in the Quality Cancer Care Alliance (QCCA) are able to share data to improve the quality of cancer care delivered to patients, explained Sibel Blau, MD, medical oncologist at Northwest Medical Specialties, PLLC.

Data and collaboration are necessary ingredients to succeed in the transition to value-based care models, and the money saved under these models will create room to pay for unconventional therapies and services in healthcare, according to panelists at The Institute for Value-Based Medicine meeting in Seattle, Washington.

The Institute for Value-Based Medicine travels to New York City to learn how technology and trust are key to making the leap to two-sided risk.

For 2017, New Jersey's largest insurer made particularly good progress in certain diabetes measures and in cancer screenings.