An Open Discussion on Value in Oncology Care at the NCCN Policy Summit

While the world “value” has been overworked by the healthcare industry, there’s still seems a lack of consensus on what it embodies. One would think, “to each his own”—but when it comes to care decisions, especially in oncology, a mutual agreement among stakeholders would be ideal.

At the NCCN Policy Summit on Value, Access, and Cost of Cancer Care, an assorted panel of experts discussed The Value Proposition in oncology. Moderated by Scott Gottlieb, MD, fellow at the American Enterprise Institute, and a participant in The American Journal of Manages Care’s Oncology Stakeholders Summit, panelists included Joseph Alvarnas, MD, director, Value-Based Analytics, City of Hope Comprehensive Cancer Center and editor in chief of Evidence-Based Oncology; Gwen Darien, executive vice president, Programs and Services, Cancer Support Community; Stan Gerson, MD, director, Case Comprehensive Cancer Center; Mike Kolodziej, MD, national medical director, Oncology Solutions, Aetna; and David Rubin, manager, Health Outcomes and Quantitative Analytics, Memorial Sloan Kettering Cancer Center (MSKCC).

“Do you have discussions with stakeholders on how they are assessing value?” Dr Gottlieb asked of Ms Darien. “We are holding these discussions with multiple stakeholders and patients are contributing as well,” she said, adding that there is an incredible will among the various stakeholders that her organization is working with to bring to the table.

Dr Gottlieb then asked the payer on the panel how they are defining value and what measures are being integrating into their system to quantify this thus-far abstract concept.

“When we think of value, we are thinking about the outcomes,” said Dr Kolodziej. “Based on the available information, we’ll evaluate whether the survival data is compelling enough. But there can be serious issues with the quality of data being presented or shared.” Dr Kolodziej explained that in order to make things better, its essential that we think about implementing the gathered data into coverage policies, adding that the societal value of an academic center is very hard to quantitate. “We need to identify process measures that can be useful surrogates for health outcomes. We are trying to achieve that with our care models and collaborations such as with the University of Chicago,” he added.

“It’s more expensive to get care at academic medical centers. I have put out an invitation to these institutions…the initial construct would be to dissect costs of care and identify areas or opportunities to cut costs. And I want to know where your institution does better.”

“The idea of managing a population doesn’t mean going to or not to an academic center. We need to be mindful of risk-adapting strategy,” said Dr Alvarnas. “With changes in healthcare economics these centers need to re-business themselves. They need to develop partnerships, locally if possible, so patients don’t have to travel too far. This would provide quality service that is also economical.”

According to Dr Kolodziej, dissecting the components of the cancer care delivery system could allow for identifying specific vital elements in the care journey.

“Public good is not divorceable from individual good. Incorrect pathological diagnoses are common, and inaccurate diagnoses can alter treatment regimens,” explained Dr Alvarnas when discussing ways and means to improve outcomes. “Although we know what treatment costs, we don’t have a handle over what the cost of incorrect therapy is.”

Mr Rubin explained that at MSKCC, they acquired large commercial data sets, instead of evaluating smaller groups of data, to conduct reproducible analysis, and then challenged carriers to assess their own data and understand wastage. “So even if you pay more in the per service cost (fee-for-service), there is a good return of investment,” he said.

Dr Gottlieb then asked Dr Alvarnas to explain the strategies that academic medical centers utilize to identify risks in a population. “We are looking at non-overlapping populations in terms of risk. Divergent populations are not routinely coded for reimbursement, so we need to adapt accordingly,” said Dr Alvarnas. “Being able to capture risk so it is transparent to us, patients, and payers is a value proposition.”

Mr Rubin added that ideally, comparative analysis using external sources is important. “We are struggling though to find the best method for achieving this.”

Ms Darien advised that it’s important to bear in mind that cost here is not just the medical cost of care— it’s the cost overall for care as well as other routine costs that the patient is faced with: loss of working days, transportation, rent, food etc. “And we have to remember that this cost impacts the patient and the society as well,” added Ms Darien.