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COA Payer Exchange Summit 2016

Dr Karen van Caulil on Value-Based Oncology Care Models for Large Employers

When transitioning towards value-based oncology, large employers should look to value-based models that have worked for other conditions, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. These successful payment models include patient-centered medical homes, bundled payments, and accountable care organizations.


When transitioning towards value-based oncology, large employers should look to value-based models that have worked for other conditions, said Karen van Caulil, PhD, president and CEO of the Florida Health Care Coalition. These successful payment models include patient-centered medical homes, bundled payments, and accountable care organizations (ACOs).

Transcript (slightly modified)

What value-based reimbursement models have worked well for large employer groups?

For many years, employers have had a value-based benefit design—at least the large self-funded employers have—and I’ve seen a lot of success in that, but it hasn’t been in the oncology space. So other payment mechanisms, other care models that have worked: the patient-centered medical home concept for care has been something that the employers have really embraced. They have eliminated the co-pays and the deductibles if their plan members access care at a patient-centered medical home. The early indications data-wise are that the patients who have chronic diseases are better managed, so the costs have dropped somewhat. We’re seeing fewer emergency department visits, fewer hospitalizations, so that model has worked very, very well.

They’re just now getting into bundled payments; it had started with hips and knee replacements primarily. A lot of value there because they are the best providers and the cost is known on the front end, and they’ve figured out how to steer patients that way and that’s worked really well. Starting to look at labor and delivery as a bundled payment, so there may be some opportunities there. Obviously, cancer is a lot more complex than some of these other 1-time events, if you will.

And ACOs, it’s taken longer than I thought for the employers to work with the ACOs in Florida, but starting January 1st, 2017, we have quite a few of our employers who have contracted with the hospital-based ACOs, so we’ll keep our eyes on how that plays out.

 
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