Experts Share Final Thoughts on Delivering Better Value-Based Care in Oncology

Alan Balch, PhD: I think the third rail here is the absence of people figuring out what value is and how to create a true economic platform. We can all come together as stakeholders with a mutual interest in delivering good-quality, high-value healthcare.

I think what needs to be at the center of that is the patient—I mean from an IOM (Institute of Medicine) definition of the word patient-centeredness. I think if you do that, it gives you a central organizing principle around which to organize payment, delivery, support services, etc.

Right now, it’s disjointed. We don’t have that level of coordination around the central “something.” If we can put patients and [make] sure they get the care that they want, need, and deserve [first], and deliver that [care] in a way that makes sense, that’s the conversation we need to have. So, having a collaborative table with, literally, the patient [at the center] and [also] figuratively at the center of that conversation—[that] is where to start.

Ira Klein, MD, MBA, FACP: I think we can’t be afraid of the complexity of the system—[we can’t allow that] to prevent us from engaging in multi-stakeholder debate. If we try to, as Ted said, air drop solutions, they are probably not workable solutions because the system is like a Rubik’s cube. We cannot alter it in one way without having an untoward consequence. We just can’t be afraid of complexity.

As proof that the system is not right and there are other ways of managing the inefficiencies, think about this: I read a report that said that of 7 exchange programs in Texas, all but 1 excluded MD Anderson. What does that tell you about how people are managing their networks or the fact that Anthem is suing its PBM (pharmacy benefits manager), saying that they’re withholding several hundred million dollars worth of value?

When I read those things, I think that within that complexity are solutions that really have to do with the operations of healthcare or the supply chain of healthcare—a lot of hidden costs and transactions that we do need to bring some transparency to. That’s where the solutions will reside.

Ted Okon, MBA: Yes, there is a problem on the drug side, and I think companies like Johnson & Johnson, Janssen, and Lilly have to get a handle on, and rethink, the pricing and the payment of these drugs. But, I think that we also have to realize it’s a bigger world out there. The pie chart is a lot bigger in terms of the component cost and the cost drivers of the cancer care. That pie chart is not just 2-dimensional; it has a third dimension—the site of care. Until we really think about this comprehensively, and go [beyond going] after the drug side (because it’s great and it reads great in the media, and everybody likes to bash the drug companies), we’re not going to get a basic handle on moving forward in terms of controlling the cost of treating cancer.

Michael Kolodziej, MD: It’s good that we’re having this discussion. It sometimes is a little bit uncomfortable, but that’s okay. Sometimes things that are really important are uncomfortable.

The path forward clearly involves collaboration. We have to recognize that the CMS (Centers for Medicare & Medicaid Services) is the single largest payer in America. They deal with perhaps the most vulnerable of all populations—seniors on fixed incomes. So, commercial insurers and CMS need to be part of the discussion. We should kind of check our attitudes at the door when we have these discussions because I think that the path forward is going to involve everybody giving a little bit. But, I do think there is a path forward [that is] better than what we’ve got now.

Bruce A. Feinberg, DO: My thanks to you, Mr. James Gilroy, Dr. Alan Balch, Dr. Ira Klein, Mr. Ted Okon, and Dr. Mike Kolodziej. On behalf of this panel, we thank you for watching, and we hope you found this American Journal of Managed Care Peer Exchange informative, as well as enjoyable and entertaining.

To hear additional insights from panelists and from other experts in the field, please join us as the Oncology Stakeholders Summit Series continues.