Value-Based Care

Through accountable care organizations, physicians are leveraging data and partnerships to create an efficient, quality-oriented system focused on improving patient outcomes and addressing health disparities.

No generalized statements regarding nurse practitioners’ low-value care ordering practices can be made due to limited evidence, indicating a need for further research.

For many patients with myeloproliferative neoplasms (MPNs) and myelodysplastic syndromes (MDS), their disease will be chronic, giving them a long-term cancer experience, said Jennifer Vaughn, MD, of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital.

At an Institute for Value-Based Medicine® event cohosted by The American Journal of Managed Care® and Optum, speakers emphasized that innovation is urgently needed in primary care delivery to address the broken US health care system.

If we are to achieve the clinical and economic benefits of primary care and care continuity, the implementation and evaluation of strategies that reward clinicians and patients are warranted.

Experts discussed the Enhancing Oncology Model and themes in the movement toward value-based care in oncology during Patient-Centered Oncology Care 2023.

Health insurance enrollment through the Affordable Care Act (ACA) insurance marketplace has broken a record for the third consecutive year; attention-deficit/hyperactivity disorder (ADHD) treatment prescriptions for adults surged during the COVID-19 pandemic, contributing to lingering shortages; paying high rent can shorten your lifespan.

Kimberly Westrich, MA, of the National Pharmaceutical Council, explained how she envisions value assessment tools to be used in the US health care system in coming years.

While the Enhancing Oncology Model is the successor of the Oncology Care Model, it includes some very real challenges for participating practices, explained Lalan Wilfong, MD, senior vice president of payer and care transformation at The US Oncology Network.

In 2023, there were 18 oncology and 7 population health Institute for Value-Based Medicine® events cohosted with organizations such as Optum, OneOncology, Vanderbilt Ingram Cancer Center, Duke Health, Cleveland Clinic, and Memorial Sloan Kettering Cancer Center.

Top coverage from the National Association of Managed Care Physicians (NAMCP) Spring Managed Care Forum 2023 included sessions on value-based care implementation and best treatment practices.

Robert Groves, MD, of Banner | Aetna discusses the challenges primary care practitioners (PCPs) face when addressing social determinants of health (SDOH).

Patients seen at value-based care clinics received more preventive screenings and had lower risks of hospitalization and emergency room visits, according to Humana’s 10th annual value-based care report.

Michael Yim, MD, board-certified family physician, discussed the need for and logistics of collaboration between oncologists and primary care providers.

In an interview with The American Journal of Managed Care®, Grant Andres, BSc, DC, BSN, MSN-RN, senior director of clinical operations at Arizona Oncology, discussed the nuances of successfully implementing value-based care initiatives across a large organization.

Amitkumar Mehta, MD, MBA, University of Alabama at Birmingham, notes the long-term data and potential curative effects of chimeric antigen receptor (CAR) T-cell therapy, while expressing optimism about bispecific therapy with ongoing evolution and the chance of significant patient responses.

Edward "Ted" Arrowsmith, MD, MPH, medical director for pathways at OneOncology and managing partner at Tennessee Oncology, highlights the need for trust between payers and providers, as well as finding balance in building consistent clinical pathways while prioritizing specific practice needs.

Investigators propose potential payment models for gene therapies that consider equitable patient access and payer reimbursement.

There is a lot of noise in the health care system, and oncologists need to collaborate and decide on common shared goals, said Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

Leveraging technology intelligently can make the patient-doctor interaction much more seamless and connected, said Samyukta Mullangi, MD, MBA, medical director of oncology at Thyme Care, medical oncologist at Tennessee Oncology.

This 2022 survey of Medicare accountable care organizations (ACOs) shows significant growth in non-Medicare value-based contracts and in contracts with downside risk.

The Enhancing Oncology Model is trying to address a number of the systemic challenges oncology faces without giving practices the tools and resources they need, said Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance.

Sophia Humphreys, PharmD, MHA, BCBBS, discusses highlights of the Institute for Value-Based Medicine® (IVBM) event, held in partnership with Providence Health System, that recently took place in Newport Beach, California.

Federal actuaries have projected what they believe to be health care spending through 2030-2031 in 9 important areas.

Through the integration of a population health reimbursement model in 2020, Allina Health Cancer Institute was able to implement expanded screening initiatives through the use of artificial intelligence and precision medicine, according to Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health.

Melissa Levine, MD, a family medicine specialist at Arizona Community Physicians and medical director for the Abacus Health accountable care organization (ACO), discussed strategies for succeeding in an ACO and how primary care can complement oncology care for patients with cancer.

At the 2023 COA Payer Exchange Summit being held October 23-24 in Reston, Virginia, Lalan Wilfong, MD, US Oncology Network, emphasizes the importance of oncology care equity, ensuring continuity of care, and enhancing care coordination.

This analysis demonstrates value and innovation of direct-acting antivirals for the treatment of chronic hepatitis C in the US Kaiser Permanente health system.

Kristine Slam, MD, FACP, Central Ohio Surgical Associates, addresses the importance of involving patients in decisions regarding their goals for treatment, emphasizing that this involvement is critical to uncover what they value, as well as their short- and long-term goals for treatment.

Alma Habib, MD, The Ohio State University Comprehensive Cancer Center, talks about the fact that disparities are able to be recognized in leukemia/lymphoma care, but the questions of how to address these disparities remain.