The Challenge of Living in Both FFS and Value-Based Care Worlds

With the high costs of care in oncology, value-based care is extremely important, but the transition is challenging when providers are still being paid by fee for service, too, explained Lalan Wilfong, MD, senior vice president, value-based care, Thyme Care.

This transcript has been lightly edited.

Transcript

What was discussed about value-based care in your COA session?

Value-based care is super important for oncology delivery at this time, because of the costs of care that we're facing, and specifically in the 2 sessions I’m moderating, one with the payers [they] have a deep understanding, from a payer perspective, of what motivates them to pursue value-based care models in oncology, and what steps do they need to take to make sure models are successful for them as a payer. And then the other session, we're going to talk about utilization management, the pros and cons of utilization management and how that needs to adapt and change to ensure all [stakeholders] are getting what they need from the delivery of care that we provide.

What are the most significant challenges when transitioning from a fee-for-service to a value-based care system?

There are significant challenges when transitioning from fee for service to value-based care. [The] biggest is that we end up living in both worlds with very different incentives, where one rewards us for procedures and doing things and the other rewards us for giving the right care to the right patient at the best value. That transition can be extremely challenging as we understand the financial implications and the practical implications on a practice for delivering the differences between fee for service and value-based care.

How can collaboration be fostered between payers and providers in a value-based system?

The biggest thing with collaboration, which I'm really excited about this meeting to be able to start these conversations, is truly having a conversation around that collaboration. As we start to understand what motivates payers and what they need in value-based care models, what practices need to be able to deliver value-based care, and what the patients need in order to do that, as well as we bring stakeholders together and start to really listen and understand what everybody's needs are, then we can start moving the field forward and continuing to move the field forward so that all stakeholders are getting what they need from value-based care.

What innovations or trends do you think will have the biggest impact on value-based care?

First and foremost are the drugs. I mean, we're in a rapid discovery of new drugs and new therapeutics for cancer care, which are greatly impacting the outcomes of our patient population, which is exciting, but they come at a cost. Because it's very costly to deliver this targeted, molecular-based therapy to our patients to drive those outcomes. I think those innovations are great and fantastic, but we're going to have to have to understand, how do we actually pay and deliver that care in this country?

Then I think the other 2 big things are technology. As we continue to advance our technology, it should help us and drive us forward in doing value-based care as we integrate our technologies better, as we start using artificial intelligence and large learning models to help us be able to deliver the right care to our patients. It's going to be transformative of what we're going to be able to deliver.