Lili Brillstein Outlines Challenges of Incorporating Value-Based Care in Oncology

New technologies and quick drug approvals contribute to the challenges of incorporating value-based care in oncology, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Transcript:

In your opinion, have we reached a turning point in the transition from fee-for-servise to value-based care?

I think there's much more movement now than there has been at all in the past. I do think so. There's evidence of success in a lot of places in these models and they're being studied and copied. I certainly try as much as I can to bring people together and have these discussions and talk about how we create success. From my perspective, it's really about the partnerships. It's really about cultivating a level of trust and respect that's been sorely lacking in this whole space for a long time. I do see change, I do see more movement than I've seen before. I think it is slow. I think it's important that the health plans begin to come into the space. I see that happening more than I did before, for sure.

What are the challenges of successfully implementing value-based care models in oncology?

The two things that were mentioned, new technology, quick approvals of new drugs, certainly make oncology a more challenging set of diagnoses to model than some others. But again, being able to design a model around oncology, or really any other chronic disease, requires the same sorts of things that are required in any models. We have to identify what's the qualifying criteria, what actually lands somebody in one of these models. What are we going to look at in terms of timeframe? What's day one? Is it your date of diagnosis? Is the first day of chemotherapy or some other treatment, is it surgery? Is it admission? Whatever it is, whatever the partners agree on, then how long do we measure it? I think as long as there's a construct and the stakeholders work together to identify what will be measured and how it will be measured, that begins to make it a little more concrete and easier.

Getting to the question around the new technologies and the drugs and how you deal with that, I think that becomes very tricky. There have to be rules about it. Again, there's no hard and fast rule. I think it's what the partners agree on. It could be that certain things are carved out for the first period until they become standard and then you rebase the financial target based on whatever the new costs are. I think there are a number of ways that you could address that. Again, to me, it's about what gets agreed upon between the partners, what makes the most sense.