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Institute for Value-Based Medicine: Philadelphia Region, Fall 2019
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Institute for Value-Based Medicine: Philadelphia Region, Fall 2019

Matthew Gavidia and Jaime Rosenberg
Speakers from major area cancer centers and Independence Blue Cross addressed progress in implementing value-based care initiatives during a session held September 19, 2019.

Facilitating the Qualitative Improvement of Oncology Through Value-Based Care

As he started the meeting alongside cancer care leaders from the Philadelphia, Pennsylvania, area, moderator Lawrence N. Shulman, MD, FACP, FASCO, deputy director for clinical services at the Abramson Cancer Center of the University of Pennsylvania, highlighted the central quandary of the US healthcare system:

“In cancer, our outcomes in this country are not as good as they are in other places,” he said, opening the September 19, 2019, of the Institute of Value-Based Medicine®, an initiative of The American Journal of Managed Care®. “In spite of the fact that we’re spending huge amounts of money, somehow our patients aren’t
doing quite as well, and I think that is a very disturbing finding.”

Getting better outcomes—without more spending—will mean doing things differently. To further discuss this, Shulman turned to Richard Snyder, MD, executive vice president of Facilitated Health Networks and chief medical officer of Independence Blue Cross; and Justin E. Bekelman, MD, director of the Penn Center for
Cancer Care Innovation at the Abramson Cancer Center.

Payer Perspectives on Advancing Value-Based Care Agreements
Focusing on the high healthcare prices in Philadelphia and other regional metropolitan areas, Snyder discussed the impact these costs have in keeping and attracting business. “For many P&Ls [Profit and Loss statements], the second line item behind labor is healthcare cost,” said Snyder. Currently, US healthcare spending per capita accounts for approximately 18% of the nation’s gross domestic product, which Snyder says is dangerously close to 20%, and a line the country cannot cross.1

For employers, the transition from fully insured to self-funded healthcare is an issue that arises as companies grow. Snyder stressed that when healthcare claims cause reinsurance costs to become more than a business can bear, funding for healthcare becomes derailed. When patients experience cost shifting and a lack of cost transparency, it can cause them to delay treatments and preventive care, even though this can lead to increased treatment costs in the future. The rise in co-pays and member out-ofpocket costs occurs with high-deductible plans. For many patients, Snyder said, high out-of-pocket costs and a lack of healthcare knowledge contribute to healthcare-related bankruptcy.

To address the public’s limited understanding of how the healthcare system works, quality information is vital to allow for more informed decisions to be made. Snyder emphasized the need to publish more information about the quality of care, although this process has been met with lawsuits from medical centers claiming defamation. “How many people ask their physician: How many cases do you treat and what are your outcomes? Patients are scared to do that; they’re fearful it will insult the physician, even when it is their life,” said Snyder.

Nevertheless, inviting patients to discuss treatment options for their conditions and providing them with ample information to make good decisions is a process that is expanding. In Pennsylvania, some hospitals are designated as Blue Distinction Centers, meaning they are recognized for their expertise in delivering specialty care.2 Snyder says that these newer models can assist in ameliorating costly treatments by prioritizing the concept of value-based contracting. How patients experience care is a variable Snyder said is growing in importance. Heightened accountability toward physicians and medical centers is being achieved through tools such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey.3

In lowering costs and improving care, Snyder described the concept of “Engage, Enable, and Empower,” which are steps that can be used to shift the focus toward patients:

ENGAGE focuses on the value-based contract and the total value of care, promoting the responsibility of the health system to work with physicians for at least 1 year to take better care of insured patients. These contracts promote value-based care through tools like HCAHPS, and quality targets that would promote a 50:50 share for surpassing them and a 50:50 loss when missed.

ENABLE represents the process of gathering information and exchanging data for analytical processing. The expanded data exchange would include variables such as electronic health record extracts, claims, lab results, and Admit-Discharge-Transfer messages in their databases, while additionally including opportunity analyses for analytics-based monitoring and reporting.

EMPOWER uses the obtained information to increase opportunities for the use of innovative services (eg, telehealth to manage postacute care and home care) in order to increase care delivery options for patients. Snyder describes this as the most powerful step.

“This concept of doing everything the way we’ve always done and getting a different outcome just doesn’t work, we’ve got to change the way we think, we’ve got to break the old mold and build anew if we ever hope to get out of the mess that we’ve found ourselves in this country,” said Snyder.

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