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Value-Based Care Is Changing Cancer Treatment Decisions as Drug Costs Continue to Rise

Laura Joszt
As novel therapies drive up the cost of drugs, it is becoming increasingly difficult for community oncologists to keep costs below value-based care program targets, according to a new survey from Integra Connect.
Community oncologists are caught between the movement to value-based care, with its aim to reduce costs while increasing quality, and the rising prices of innovative therapies that can be life saving for patients, according to a new survey from Integra Connect.

The 530 respondents all said they were participating in some sort of value-based care, with 38% in Medicare’s Merit-based Incentive Payment System (MIPS), 54% in the Oncology Care Model (OCM) and MIPS, and 8% in chronic care management and MIPS. The respondents are optimistic about the future of value-based care in oncology, with 90% saying they are interested in alternative payment models (APMs) beyond the OCM, although only 3% are already participating in models other than OCM.

Drug costs remain, by far, the biggest challenge to value-based care in oncology. More than half (57%) said drug costs were the top challenge, followed distantly by reporting requirements (19%), reducing emergency department visits (14%), transforming the practice for success (5%), and getting the right skills, workflow, and technology in place (5%).

A majority (87%) said that value-based care is causing them to think different about drug choices, with 30% accelerating efforts to incorporate precision medicine, 26% considering the impact of each therapy’s cost, 17% increasing their use of clinical pathways, and 13% increasing efforts to anticipate quality. The respondents mostly thought precision medicine held promise to accelerate the appropriate use of novel therapies, with 66% strongly agreeing and 28% somewhat agreeing.

In addition, 38% said they will seek to develop a deeper understanding of drug value and another 38% said they may change their drug choices and opt for lower-cost therapies when efficacy and toxicity are the same.

Respondents also thought pharma could be more helpful when it comes to understanding the overall value, not just the cost, of therapies. Only 7% said pharma has been very helpful, whereas 64% said pharma has not been helpful. The 2 areas where respondents said pharma could be more helpful so they can make more informed decisions were better data about care quality and outcomes (29%) and better data about treatment costs (25%).

“With clinical outcomes rightly considered non-negotiable, this data shows that community oncology is seeking new frameworks for understanding the comprehensive value of novel therapies and other high-cost treatments,” Jeffrey Scott, MD, chief medical officer of Integra Connect, said in a statement. “It is not an effort they believe that they can—or want to—undertake alone. While oncologists say pharma is not at the table today, they’re expressing the need for new data and insights that only manufacturers can provide. In addition, they foresee the need for closer payer cooperation in order for future generations of value-based reimbursement models to be successful.”

 
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