FEATURE
Defining “Value” in Value-Based Medicine
Continued from page 42
standardization of treatment, may or may not
be embraced.”
Complicating the idea of value further are
the degrees of variance among physicians and
patients themselves. “Individual people will
disagree on how to prioritize things like length
of life versus quality of life,” Dr. LeBlanc said.
“While one person may want to take any measure to extend his or her life as long as possible,
others may not want to put themselves through
certain treatments or procedures if they only
have three months left to live.”
The Complications of Hematology
There are unique challenges within the field of
hematology that make measuring value more
difficult. In other specialties, measuring patient
outcomes can be more straightforward. For
example, in cardiology, value and outcomes
can be measured by patients maintaining blood
pressure or cholesterol goals, or by reducing the
rate of hospital readmission for patients with
heart failure.
According to Dr. Bolwell, hematology is
one of the most intellectually complex specialties in medicine, for treating both malignant
and non-malignant disorders.
“Malignant hematology alone includes diseases, like acute leukemias, that are treated with
fairly dramatic interventions, like bone marrow
transplantation, that requires intensive inpatient
hospitalization and tremendous utilization of
health-care resources,” Dr. Bolwell said.
hematologists are taking care of patients, we are
sending them for tests to look at genes or chromosomes, while also working to develop drugs
to target those things. That kind of innovation
is costly.”
A Special Symposium on Quality at the
2014 ASH Annual Meeting discussed the
rising cost of medical care, including the
rapid increase in new drugs becoming available every year, and their associated costs.
(Editor’s note: For coverage of this and other
news from the 2014 ASH Annual Meeting,
turn to page 32.)
“Many diseases in hematology are rare
diseases, and there is a big cost associated
with developing treatment with fewer patients
to deliver those drugs to,” Dr. LeBlanc said.
“Companies need to make a return on their
investment so they are able to continue to
develop helpful therapies. We need to start
thinking about the appropriate balance between innovation and profit and ask ourselves,
‘When is it too much?’”
More Value, Less Health Care?
As the system shifts to a more value-based
model, it may be intuitive to think that better value equals fewer interactions with the
health-care system. However, Drs. LeBlanc and
Bolwell believe that higher quality health care
will require the opposite.
“High-value care requires more encounters with the health-care system and,
“ e have to improve the quality
W
and nature of our interactions. If our
patients better understand the goals of
treatment, they might make different
choices or reorder their priorities. ”
—THOMAS W. LE BLANC, MD
The area of non-malignant hematology
includes a group of uncommon – and clinically
intensive – diseases. Thrombotic thrombocytopenia purpura, for example, is associated with
significant resource utilization and long-term
toxicities and related illnesses.
“Because these diseases are not particularly
common, defining value and quality metrics to
measure is not as straightforward as in other
subspecialities,” Dr. Bolwell said.
In addition, hematology – especially in the
area of hematologic malignancies – has been at
the forefront of genetic personalized medicine
for a few decades, Dr. LeBlanc added. “The
first truly targeted treatment was for chronic
myeloid leukemia,” he said. “Increasingly, when
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ASH Clinical News
certainly, more meaningful encounters,” Dr.
LeBlanc said. These interactions will start in
the primary-care setting with patients seeing
their prima '