Patients Are the “Value” Focus in Cancer Care, Panelists Agree

There are many sources, and definitions, of where the value in cancer care lies. In this panel discussion, a cancer survivor and patient advocate, an oncologist, and a benefits professional provided their perspectives on what value in cancer care means to them.

How do you define value in cancer care? A panel discussion on day 1 of the 2021 virtual Community Oncology Conference attempted to answer this question and provide a well-rounded definition that incorporated several points of view from a cancer survivor and patient advocate, an oncologist, and a benefits professional.

Moderated by Bo Gamble, director of Strategic Practice Initiatives at the Community Oncology Alliance (COA), “Defining Value in Cancer Care: Patient, Physician & Employer Perspectives,” was an active discussion and proved that the value in cancer care cannot be confined to one definition. There are many sources, and definitions, of where the value in cancer care lies.

Joining Gamble for the discussion were:

• Tomy Ramey, 11-year cancer survivor, patient advocate, and COA Patient Advocacy Network advisory board member, who provided the patient perspective
• Edward Licitra, MD, PhD, medical oncologist and chairman and CEO of Astera Health Partners, wh0 provided the physician perspective
• Beth A. Curran, senior director, Risk Management, Orange County Public Schools, who provided the employer perspective

“I've been looking forward to this conversation about value and what it means to different people,” Gamble said in kicking off the discussion. “It seems that all of these reform initiatives are teaching us one thing: that value is in the eye of the beholder. For the participant. So I want to start the conversation with asking you each, how do you define value in cancer care?”

The responses came fast, and they were fervent.

“In many ways, value is in the eye of the beholder,” Licitra, who is also on the COA Board of Directors, stated. “However, from my perspective, I think we can at least align around 3 major topics: improving patient outcomes, enhancing the patient experience, and controlling the cost of health care.”

“Patient outcomes are critical in cancer care,” he continued, and “we do everything we can to put the patient at the center of our health care ecosystem. But this revolves around cost, and I think controlling the cost of health care is something that we should all be focused.”

A system of care that is valuable to everyone is the ultimate goal, he added.

For Curran, the value focus is on tearing down roadblocks to care, “so employees and members don't have issues getting the treatment they need, getting the scans that they need.” And this should encompass both cost measures and quality benchmarks. “Cost factors into it, quality factors into it. We want our employees to be able to get the care that they need, when they need it, without having so many roadblocks that possibly delay their care.”

For her school district alone, the 37,000 plan members account for an annual medical spend of $250 million, $66 million of which is covered under oncology and neoplasms, she noted.

“For me,” Ramey replied, “I would have to say the value in cancer care was access to my doctors and access to my nurses. I went to a community clinic, and everything was right there: the labs, the scans, the pharmacy. Now, having everything is one location was really important, but for me personally, the value in cancer care was accessibility to my doctors and their staff. I'm 11 years out, but I know all I have to do is pick up the phone and call if I have a problem and they are right on it.”

Ramey also had a patient navigator, for which she is now a big advocate, because she wasn’t just a number to them, she was a person. Her patient navigator was there from the beginning, when she first got the “C word” diagnosis, she noted. “You realize that value from day one that I'm important and my life matters to these people.”

Gamble continued this discussion by asking a follow-up question to Licitra and Curran, “What are you doing to promote the view of value to your patients or your employees?”

Everything needs to be patient centered, Licitra stressed, particularly getting them the right care as quickly as possible—this is what creating value in health care delivery means. He also echoed Curran’s earlier comments about breaking down care barriers. To do this, he continued, systems of care should be set up so that every patient “gets the same level of care, the same level of connectivity, the same level of efficiency.”

This can prove especially difficult, however, when making employees aware of new service offerings quickly, Curran said, “because if you don’t need a service at the time you get the message about it, when you need it 3 months down the road, you may even forget about it. And they may not want to call their employer.”

It’s all about keeping patients in the know and considering their various needs, Ramey, Curran, and Licitra emphasized, encompassing not only access and communication but also understanding the total cost of care, both direct and indirect.

“What I'm seeing more and more, which is refreshing, is that we're taking a much more holistic approach to understanding how patient care should be delivered and how it affects the total cost of care,” Licitra stated. “Because these are the discussions that will help us move the needle, that's where how we're going to improve patient outcomes, and that's how we are really going to deliver value in cancer care.”

“You can get chemo in lots of places,” Ramey added, “but it’s the compassion and the care and the personalization and the communication on what’s going on with you that made such a huge difference for me.”

Gamble closed the discussion by asking the panel to think about how they could find a common understanding about value and teach each other, as well as other stakeholders, what’s important in cancer care.

We need to collaborate and to be willing to have frank discussions on what does and does not work well and to ask if we are doing a good enough job or should be doing more, all in order to create a better care delivery model, the panelists agreed.

“Keep the lines of communication open,” Ramey emphasized, “and always ask, ‘How can we work together to make it better for all?’”