Payers’ Perspectives on Cancer Care

TOP - January 2021 Vol 14, No 1 - AVBCC Summit Highlights

In an environment of increasing vertical and horizontal integration in healthcare, are new value-based care models in oncology—such as the Centers for Medicare & Medicaid Services’ pilot payment project, the Oncology Care Model (OCM)—working? Five years from now, will we still be talking about efforts to go from volume to value using alternative payment models?

Those were some of the key questions posed to leading representatives from payer groups of all sizes, ranging from regional health plans to the biggest national payers, at the 10th Annual Summit of the Association for Value-Based Cancer Care (AVBCC) in 2020. The discussion was moderated by Michael Kolodziej, MD, FACP, Senior Advisor, ADVI Health.

Many of the participants in this discussion agreed that the OCM, which currently involves approximately 25% of oncology practices in the United States, is likely not scalable beyond the regional level.

“I think we need a solution for America, not the best 25% of practices,” Dr Kolodziej said.

“The concept of value-based care still has a pulse in oncology, but it needs to be parsed out into engagement with large volumes of patients,” agreed Roger Brito, DO, Division Head, Enterprise Oncology, CVS Health.

Other hot topics included whether to eliminate buy-and-bill; shifting value-based models from managing hospital and emergency department admissions to serving as the major driver of oncology spending, namely, drug costs; the high cost of end-of-life care; and the paucity of evidence driving 3 and 4 lines of therapy and beyond in oncology.

“The game needs to change,” said Dr Brito. “The guidelines are pretty clear for early-stage therapy and usually involve the same regimens. In late-line therapies and very advanced cancers, quite frankly, we need to do better. That’s where there’s a real opportunity to have discussions about palliative care and improve on care delivery in the US.”

Related Items
The Future of Genetic Therapies and Value-Based Care in Oncology
William King
TOP - May 2022 Vol 15, No 3 published on May 6, 2022 in AVBCC Summit Highlights
Community Provider Perspective: The Current and Future State of Cancer Care
William King
TOP - May 2022 Vol 15, No 3 published on May 6, 2022 in AVBCC Summit Highlights
Biosimilars and the Road Ahead: Experts Discuss Opportunities and Challenges
William King
TOP - March 2022 Vol 15, No 2 published on March 16, 2022 in AVBCC Summit Highlights
Oncology Support Services Need to Go Beyond Simply Building a HUB
TOP - March 2022 Vol 15, No 2 published on March 16, 2022 in AVBCC Summit Highlights
Understanding the Impact of Telehealth on Quality, Access, and Cost in Oncology Care
TOP - March 2022 Vol 15, No 2 published on March 16, 2022 in AVBCC Summit Highlights
mRNA COVID-19 Vaccine Appears Safe and Effective in Patients with Cancer Receiving Active Treatment
Charlie Dawson
TOP - March 2022 Vol 15, No 2 published on February 28, 2022 in AVBCC Summit Highlights
The Current and Future State of Medically Integrated Pharmacy in Oncology
William King
TOP - January 2022 Vol 15, No 1 – Online Only published on January 20, 2022 in AVBCC Summit Highlights
Drug Price Reform: The Implications for 2022 and Beyond
Charlie Dawson
TOP - January 2022 Vol 15, No 1 – Online Only published on January 20, 2022 in AVBCC Summit Highlights
Experts Agree That Flexibility and Adaptability Are Essential for Future-Proofing Cancer Care Against Pandemics
William King
TOP - January 2022 Vol 15, No 1 – Online Only published on January 20, 2022 in AVBCC Summit Highlights
Value-Based Contracting in Oncology: AVBCC Panel Focuses on Strategies to Improve Patient Care
William King
TOP - January 2022 Vol 15, No 1 – Online Only published on January 20, 2022 in AVBCC Summit Highlights
Last modified: July 22, 2021