Who Determines What ‘Value’ Looks Like in Value-Based Cancer Care?

In addition, high patient cost-sharing (ie, out-of-pocket costs) is known to negatively impact adherence to treatment and is thought to contribute to financial toxicity.^1,4,6  In this context, providing financial incentives to patients could add value to a cancer treatment by increasing adherence.^1,4

Conversely, patients and providers have very different perspectives about how value is created in cancer care.⁷ From a provider perspective, the definition of value should encompass clinical, physical, emotional, and psychosocial outcomes of a treatment, Dr Zafar told Cancer Therapy Advisor. He added that a “high-value treatment” is one that extends survival and has limited toxicities — and theoretically, it should also prevent future tumor growth or halt cancer progression. Thus, it is very challenging to integrate all aspects and perspectives of value into one definition.⁷

A patient-focused, value-based approach that encourages reporting of patient outcomes, among other measures of quality, requires staff training and education.³ Evaluation of patient-reported outcomes (PROs) is an important component of measuring quality, and many studies have pointed to the role of PROs in improving care quality and extending overall survival.¹

Although the OCM is a small pilot evaluating 200 practices, several providers are already seeking to integrate PROs and other patient-centered parameters into their clinical workflows. Similarly, making PROs publicly available for patients will further drive the utilization of high-value services.¹

In conclusion, a patient-focused, value-based approach using a mix of modest financial and nonfinancial incentives for beneficiaries will provide more support for providers to more actively engage patients in their own care. A wide range of quality measures have the potential to be meaningful for all involved parties in the cancer care continuum.

Disclosures: The author of the JAMA study reported receiving research funding from AstraZeneca. For a full list of disclosures, please refer to the original study.

References

1. Zafar SY, Polite BN, McLellan M. Engaging patients in value-based care: a missed opportunity [published online August 2, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.2826
2. Valuck T, Blaisdell D, Dugan D, et al. National Pharmaceutical Council and Discern Health. Improving oncology quality measurement in accountable care. https://www.npcnow.org/system/files/research/download/npc-improving-oncology-quality-measures-final.pdf. Published in April 2017. Accessed on September 21, 2018.
3. Wade, JC. Unwanted variation in cancer care: it is time to innovate and change. J Oncol Pract. 2017;13(1):6-8.
4. Thomson S, Schang L, Chernew ME. Value based cost sharing in the United States and elsewhere can increase patients’ use of high-value goods and services. Health Aff (Millwood). 2013;32(4):704-712.
5. Loewenstein G, Volpp KG, Asch DA. Incentives in health. Different prescriptions for physicians and patients. JAMA. 2012;307(13):1375-1376.
6. Baicker K, Goldman D. Patient cost-sharing and healthcare spending growth. J Econ Perspect. 2011;25(2):47-68.
7. Ramsey S, Schickedanz A. How should we define value in cancer care? Oncologist. 2010;15(suppl1):1-4.