Brenton Fargnoli, MD: I think, undoubtedly, that there’s a multi-stakeholder movement [toward] value in oncology—whether that’s providers, payers, or even life science companies, increasingly. And it’s just so important that as we measure the success of these programs, whether it’s measuring the success of the Oncology Care Model or Part B, or these other things, that we keep in mind that the ultimate success metric is the value delivered to that patient.

So, including them in these discussions, including them in every conversation around, “Is value being delivered?” is going to be critically important—that we don’t stray toward too much policy or [show] too much favoritism toward one stakeholder. Because, at the end of the day, the patient is at the center of this alternative payment model shift.

Rena M. Conti, PhD: I would say the following: in this rush to focus on value-based care, we lose sight of the fact that we are a very rich country that believes, strongly, in providing access to medical care for our entire population. We can afford both—to provide basic access to cancer screening and, at the same time, provide access to the most expensive, cutting-edge, precision medicine that can provide durable cures—if we spend our money wisely.

So, what I hope to see, and I think is beginning to be part of a national conversation, is a focus on how we can get this system focused on value—where we’re using money most wisely and we’re not putting patients at the center of really expensive stuff that doesn’t do that much for them or at the center of stuff that does a lot for them but they have to foot the bill “too much.” So, hopefully, we’re moving in that direction.

Andrew L. Pecora, MD, CPE: I’d like to end by saying it’s very easy to get angry and cynical about all of this, but at the end of the day, somebody has to really start to think about this. It’s wonderful that you 2 have dedicated part of your careers [to] thinking about this. And, for me, I really believe that no one has the right to do the wrong thing for a patient. We can argue about what the right thing is, and that’s always going to be an argument in medicine. But no one has the right to do the wrong thing. The better we can identify the wrong things and prevent them from happening, I think there’s plenty of money from that savings that could be used for all the things you just said.

The key, over the next few years, is to make certain that we don’t create perverse incentives or cross-incentives or we don’t have 2 parts of government actually working against each other. It’s going to take people from the economics community, from the information technology community, and from the medical community to work in partnership to make this a reality.

On behalf of our panel, we thank you for following the Fall 2016 program of the Oncology Stakeholder Summit Series. We hope you found this Peer Exchange® informative and hope you will join us as the series continues.

The Future of Value-Based Care and Payment Models in Cancer Care

Rena M. Conti, PhD; Brenton Fargnoli, MD; and Andrew L. Pecora, MD, CPE, share final considerations about their expectations given the shift from fee-for-service to value-based care in oncology.
Published Online: February 13, 2017


Brenton Fargnoli, MD: I think, undoubtedly, that there’s a multi-stakeholder movement [toward] value in oncology—whether that’s providers, payers, or even life science companies, increasingly. And it’s just so important that as we measure the success of these programs, whether it’s measuring the success of the Oncology Care Model or Part B, or these other things, that we keep in mind that the ultimate success metric is the value delivered to that patient.

So, including them in these discussions, including them in every conversation around, “Is value being delivered?” is going to be critically important—that we don’t stray toward too much policy or [show] too much favoritism toward one stakeholder. Because, at the end of the day, the patient is at the center of this alternative payment model shift.

Rena M. Conti, PhD: I would say the following: in this rush to focus on value-based care, we lose sight of the fact that we are a very rich country that believes, strongly, in providing access to medical care for our entire population. We can afford both—to provide basic access to cancer screening and, at the same time, provide access to the most expensive, cutting-edge, precision medicine that can provide durable cures—if we spend our money wisely.

So, what I hope to see, and I think is beginning to be part of a national conversation, is a focus on how we can get this system focused on value—where we’re using money most wisely and we’re not putting patients at the center of really expensive stuff that doesn’t do that much for them or at the center of stuff that does a lot for them but they have to foot the bill “too much.” So, hopefully, we’re moving in that direction.

Andrew L. Pecora, MD, CPE: I’d like to end by saying it’s very easy to get angry and cynical about all of this, but at the end of the day, somebody has to really start to think about this. It’s wonderful that you 2 have dedicated part of your careers [to] thinking about this. And, for me, I really believe that no one has the right to do the wrong thing for a patient. We can argue about what the right thing is, and that’s always going to be an argument in medicine. But no one has the right to do the wrong thing. The better we can identify the wrong things and prevent them from happening, I think there’s plenty of money from that savings that could be used for all the things you just said.

The key, over the next few years, is to make certain that we don’t create perverse incentives or cross-incentives or we don’t have 2 parts of government actually working against each other. It’s going to take people from the economics community, from the information technology community, and from the medical community to work in partnership to make this a reality.

On behalf of our panel, we thank you for following the Fall 2016 program of the Oncology Stakeholder Summit Series. We hope you found this Peer Exchange® informative and hope you will join us as the series continues.

View More From This Discussion
Episode 1 Defining Alternative Payment Models
Episode 2 Adapting and Paying for Value-Based Care
Episode 3 Value-Based Care and APMs in Oncology: A Payer Perspective
Episode 4 Is the Oncology Care Model Patient Centered?
Episode 5 Population Health and APMs
Episode 6 Benefits of a Medical Home Model in Oncology
Episode 7 Risk-Based Contracting in Oncology
Episode 8 Site of Service and the Challenge of Value-Based Care
Episode 9 Who Shares the Maximum Risk With Innovative Treatments in Oncology?
Episode 10 Leveraging Health IT in Cancer Care
Episode 11 Importance of Data Sharing in Healthcare
Episode 12 Innovative Technology and Healthcare Costs
Episode 13 The Balancing Act of Healthcare Costs
Episode 14 Patient Centricity of Care Delivery and Payment Models
Episode 15 Do APMs Incorporate Survivorship Care in Oncology?
Episode 16 The Future of Value-Based Care and Payment Models in Cancer Care
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