Value-Based Care

Explore cutting-edge discussions on patient-centered oncology, value-based care, AI innovations, and survivorship strategies Thursday and Friday at PCOC 2025 in Nashville.

On July 9, 2025, experts from across Providence Health & Services gathered in Garden Grove, California, for in-depth discussions on patient-centered care for chronic diseases.

Community oncology leaders navigate challenges in value-based care under the Enhancing Oncology Model, facing performance payment uncertainties and evolving drug markets.

Explore how payers and providers collaborate to enhance value-based care, tackle rising costs, and improve patient outcomes in today's health care landscape.

Given the track record of good outcomes and savings, policy leaders must do more to promote growth of for-profit PACE programs, the author asserts.

More large employers with high-deductible health plans with health savings accounts offer preventive drug list benefits over time.

Emilie Aschenbrenner, PharmD, BCOP, discusses how integrating CD38-targeted therapies into first-line treatment for transplant-ineligible multiple myeloma requires balancing clinical benefit, cost, and insurance coverage.

Jason Bergsbaken, PharmD, MBA, BCOP, explains the value of pharmacist involvement in precision molecular tumor boards and end-of-life care discussions, highlighting their role in ensuring evidence-based therapy selection, patient-specific recommendations, and shared decision-making that aligns treatment with individual goals.

Clayton Irvine, PharmD, MBA, MS, discusses strategies to address payer-driven biosimilar and prior authorization challenges through integrated digital solutions, while advocating for flexible, regularly reviewed treatment pathways supported by molecular tumor boards and artificial intelligence to balance standardization with personalized, biomarker-driven oncology care.

Jason Bergsbaken, PharmD, MBA, BCOP, highlights the operational challenges of value-based oncology care while emphasizing the need to balance standardized treatment pathways with flexibility for personalized, biomarker-driven care.

Jason Bergsbaken, PharmD, MBA, BCOP, highlights the growing role of real-world data in validating or de-implementing therapies, the need for vigilant postapproval outcomes monitoring, and the value of academic–community oncology partnerships.

In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on the future of value-based care and the promise—and limits—of AI-enabled innovation, reflecting on challenges like rising Medicare costs and patients’ growing financial burdens.

A meta-analysis showed that control group outcomes in psilocybin trials for depression were significantly weaker than those in selective serotonin reuptake inhibitor (SSRI) and esketamine trials, suggesting that psilocybin’s large observed treatment effects may be inflated by methodological factors such as functional unblinding and expectancy bias.

A significant number of patients with cancer, caregivers, and health care professionals face significant disparities in legal issues, with the most common needs revolving around health insurance, finances, employment, and disability insurance.

This study examined the impact of price transparency and prosocial messaging on patient engagement of price-protected consumers in seeking value-based care.

Ayodeji Adegunsoye, MD, PhD, MSc, highlights how the underrepresentation of minority populations in pulmonary fibrosis genetic studies hinders accurate disease risk prediction and broader clinical translation.

Caroline Vovan, PharmD, CDE, emphasized the expanding role of ambulatory clinical pharmacists in value-based care.

Ambulatory clinical pharmacists improve patient outcomes and reduce health care costs by providing hands-on chronic disease management, patient education, and medication cost oversight, according to Caroline Vovan, PharmD, CDE.

Caroline Vovan, PharmD, CDE, highlights how ambulatory clinical pharmacists contribute to value-based care by managing chronic conditions, improving medication adherence, and reducing costs.

The new Blueprint for Patient-Centered Value Research offers a roadmap for embedding patient voices throughout every stage of the research journey to foster more equitable, transparent, and responsive health care systems.

Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service Reduction (WISeR) Model hopes to work, and addresses concerns about delays and denials from revamped prior authorization processes.

Robert Kratzke, MD, urged insurance providers to prioritize fast biomarker testing in non–small cell lung cancer, saying it’s both cost-effective and life-saving.

Tyler Sandahl, PharmD, a clinical pharmacist at Mayo Clinic, explains that sequencing novel multiple myeloma therapies with CAR T-cell therapy is generally prioritized first for eligible patients, while bispecific antibodies are reserved for later lines or for patients unable to tolerate CAR T.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The July issue features a conversation with David J. Shulkin, MD, a physician and former secretary of the US Department of Veterans Affairs.