Balancing Cost and Quality in Oncology: A Value-Based Care Perspective

During an interview, Travis Brewer, vice president of payer and public health strategy/relations at Texas Oncology, emphasized that cost containment and high-quality cancer care are not mutually exclusive in a value-based oncology model. He advocated for an integrated approach that utilizes cost-effective treatment models while achieving strong patient outcomes.

Additionally, Brewer highlighted the importance of multidisciplinary care teams, including ancillary services like nutrition and financial counseling, as well as integrated pharmacies to enhance patient adherence and reduce waste. Regarding payment models, he noted that bundled and capitated payments can be effective if targeted carefully, but warned that rigid models often fail due to the evolving complexity of oncology care. Instead, he recommends a flexible, disease-specific approach to value-based care.

This transcript has been lightly edited; captions were auto generated.

Transcript

In a value-based oncology model, how can health care providers balance the need for cost containment with ensuring high-quality care for cancer patients?

I don't see it so much as a balance. It's almost as though—not that it was intent, but the question implies you have to give up one to get the other and I don't believe that that's the case. I think that you can have a set of high-quality outcomes and utilize the most cost-effective treatment models available. So it's and/plus, not either/or, in my opinion. And we have had some great success in our practice implementing a model just like that.

How does the integration of multidisciplinary care teams enhance the effectiveness of value-based oncology care?

Well, I think it's vital. I think the more holistically you can approach the care of the patients that we treat is to provide as many—not only the direct oncology services, but also ancillary—services, to your point around be it nutrition or social work or financial counseling, dealing with financial toxicities of what can be costly therapies at times. I think the more that you can provide under 1 roof, the better patient experience you're going to have overall.

Integrated pharmacies are another key aspect to that. The fact that we can clinically integrate our pharmacy operations and more closely manage and update as needed, [such as] oral medications. It helps to reduce waste. It helps to improve patient adherence to therapy regimens. Like I said, the more you can provide, the better the overall outcomes are going to be.

How do new payment models, such as bundled payments or capitated payments, fit into the value-based care approach for oncology, and what are the potential benefits and drawbacks of these models?

I think the biggest issue—and we've experienced this in the past and we've dealt with several value-based care models over the years—is that they tend to start off pretty good and then pretty quickly collapse on themselves, mainly because they don't know what they don't know at the outset, and oncology care is complex. So, it's very difficult to wrap a single value-based care model around something as, again, complex as oncology.

I think capitation [and] bundled models have a place, but they have to be targeted and they have to be focused. I think you need to start with certain disease types that are more easily managed and build out from there. Capitation models are a little tougher in this space, simply because you're constantly getting changes in treatment options. There are new great mouse traps coming out every day for oncology care. So, as soon as you put a capitation model in place, it almost immediately begins to leak, because of all the new things that were not contemplated when what appeared to be a very robust model when you entered into it is no longer even close to covering today's reality.

I think taking smaller bites and focusing is probably the way to approach it now and build out from there. But you always have to remain flexible, because things are constantly changing.