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NEWS
Value-based care in oncology
H
A key lesson
learned is to
develop the right
focus on practice
workflow and
changes needed
to be successful.
6
| May 2017
ealthcare reimbursement in SA is
at a crossroads. Globally, there is
a move towards value-based care,
while fee-for-service is being phased
out. Alternative reimbursement models are
being adapted to incorporate outcomes-based
reimbursements, which reward the delivery of
value by physicians. The quest to curb the rising
costs of cancer treatment without sacrificing
patient outcomes has successfully been
implemented in the US.
The Independent Clinical Oncology Network
(ICON) recently hosted an event where Diana
Verrilli of McKesson Specialty Health, based
in the US, spoke about how value-based care
has been successfully implemented in the US
Oncology Network.
The principle of value-based care is where
funders incentivise doctors for adding value and
saving costs, based on measured outcomes. A
shift to this kind of reimbursement has been
shown to deliver benefits to all stakeholders in
the sector - especially the patients.
The ICON team encountered the work of Diana
Verrilli on a recent trip to the US as guests of US
Oncology, which is the largest oncology network
in the US, spanning some 400 sites of care with a
membership of around 1400 oncology physicians.
The healthcare situation in the US is not
dissimilar to that of SA. Speaking at the event, Dr
Jacques Snyman, ISIMO Health CEO, said, “This is
an opportunity for us to learn from how the US
took ownership of the situation and made value-
based care work for them.”
Some of the strategies that have been
implemented by Verrilli and her team in the US
include using different pathways and sticking to
guidelines, to combat the cost of chemotherapy
drugs. Avoiding unnecessary hospitalisations is
also a big factor in curbing costs. This can be
implemented by care management and patient
support services. Through utilisation management,
there can be a 24/7 triage line. In this model,
funders can incentivise physicians to build a care
home model to keep patients out of hospitals.
In end of life care, advanced care planning and
responsible use of resources is recommended.
Verrilli commented that palliative care is the
hardest part to get uptake on. “Practices want to
implement it, but don’t know how,” she said.
In applying value-based care to oncology,
there is a move from fee for service to monthly
payments per month per patient - a capitated
rate or bundled payments.
“We have to start with baby steps,” said Verrilli.
“We need to focus on early wins and show
success early - make it simple in the short term.
She advocated focussing quality data on what is
most important to patient care and costs, and is
easy to collect.
Physicians need to be aligned and have the
same goals in patient care, each knowing their
role. A key lesson learned is to develop the
right focus on practice workflow and changes
needed to be successful. “Medical and radiation
oncologists should be on the same page. Build
support and care teams around the physicians,”
Verrilli advised.
Why should oncologists
make this change?
One can look at this from the perspective of
‘change before you have to’ and ‘take control
before someone else does’. Payer mergers and
unsustainable drug costs are drivers of this trend.
The idea is not to compromise care. Quite the
opposite, in fact. The programme’s goal is to
improve care but lower the cost. The premise
being that improving access to care and adding
enhanced services will result in better care as
well as smarter spending, and healthier patients.
“What we