Washington, DC—With tremendous changes occurring in healthcare and particularly in oncology, discussion about the current trends and demands facing stakeholders in optimizing value in cancer care dominated the Sixth Annual Conference of the Association for Value-Based Cancer Care, held September 27-29, 2016, and co-chaired by Michael Kolodziej, MD, National Medical Director, Managed Care Strategy, Flatiron Health, New York, NY; and Burt Zweigenhaft, BS, President, National Association of Specialty Pharmacy; and Editor-in-Chief, Value-Based Cancer Care.
These trends include the development of accountable care organizations, the escalation of personalized care, barriers to patient access, and the shifting landscape of oncology drug reimbursement.
“We are seeing dramatic payment reform proposals,” said Dr Kolodziej. “The fact that the Centers for Medicare & Medicaid Services has become the single biggest driver of change in oncology today…is amazing.”
Payment reform proposals will have a tremendous impact on patients, as well as the employers who pay a substantial portion of the bill for the majority of individuals who have health insurance.
“It’s going to impact every single person in America,” said Dr Kolodziej.
The conference presenters discussed barriers associated with cost, quality, and access as they relate to healthcare reform. Many presenters compared and contrasted the various approaches and tools that providers and payers are using to manage and deliver care collaboratively, such as the use of clinical pathways and the roadblocks involved in implementing these pathways (ie, enhanced infrastructure). The prevailing opinion regarding clinical pathways is that success with their use has been variable, because not all practices have the technology or the staff to measure outcomes or quality in the normal workflow.
Biosimilars, Value Frameworks, and Big Data
Several presentations addressed the impact of biosimilars on the cost of care and how biosimilars fit into the new payment models; conference presenters agreed that incentives created by payments based on the total cost of an episode of care should raise the demand for lower-cost biosimilars.
Although payers may look forward to the uptake of biosimilars, the total cost of cancer care may not decline, because, as Gerald Messerschmidt, MD, FACP, Chief Medical Officer, Precision for Medicine, warned, cancer is increasingly being recognized as a disease of the genome that will require the use of up to 12 drugs in combination to treat multiple cancer clones.
Payment reform models may take the form of more unique risk arrangements with providers, and more cost transference to the patient. Cost-savings measures that may be used more often in the future include closed formularies and the application of value frameworks.
The application of value frameworks in clinical practice is gaining traction in oncology. Several presenters examined the recently introduced value frameworks and explored different stakeholders’ definitions of value. In addition, several presenters also addressed the gaps in patient and employer perspectives in value-based cancer therapy decision-making, as well as the challenges in incorporating these perspectives into the future versions of value frameworks in oncology.
Another area of discussion involved the role of specialty pharmacy in managing the costs associated with innovative therapies and in optimizing patient outcomes. Price-for-performance contracting, which links the price of a drug to outcomes, is one potential solution for managing the cost of expensive monotherapies and combination therapies, but measuring outcomes of value could be problematic.
Big data in oncology was another topic of discussion. The use of quality measures to support the launch of new oncology therapeutics in a value-based environment will require improved data collection and data utilization.
“Big data is the key to identifying the best way to deliver care, the best outcome for patients, and to help inform us how to pay for it,” said Dr Kolodziej.