5 Things to Know About Value in Healthcare

From CMS to private health plans, professional healthcare organizations to patients and advocacy groups, the discussion nowadays seems to end up with value.

Value in healthcare seems to be the new mantra. From CMS to private health plans, professional healthcare organizations to patients and advocacy groups, the discussion seems to end up with value. As Dr Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, has said, however, are some of the drugs delivering diminishing returns as their price rises?

Here is an update on where the field stands with defining and computing the value of care.

1. Several Value Tools Have Been Developed in Oncology

The American Society of Clinical Oncology's (ASCO's) Value in Cancer Care Task Force has carved a conceptual framework for new cancer treatments based on their clinical benefit, toxicity, and cost compared with the available standard of care. Following DrugAbacus, which was developed at Memorial Sloan Kettering Cancer Center, the National Comprehensive Cancer Network (NCCN) has developed the NCCN Evidence Blocks for chronic myelogenous leukemia and multiple myeloma.

2. Will Payers Use Oncology Value Calculators?

In an interview with The American Journal of Managed Care, Lee Newcomer, MD, MHA, senior vice president, Oncology and Genetics at UnitedHealthcare, said that they do not, currently, have plans to use any of the new value calculators, but they will continue covering regimens recommended by the NCCN.

Listen to the interview here.

3. CMS to Evaluate VBID in Medicare Advantage

CMS has drafted a plan to test the integration of value-based insurance design (VBID) in Medicare Advantage in 7 states across the United States. The pilot, scheduled to initiate in January 2017, will test whether the new Medicare Advantage Value-Based Insurance Design model will improve enrollee satisfaction, improve enrollee clinical outcomes, reduce overall plan expenditures, and result in lower plan bids, thus saving money for Medicare and beneficiaries.

Read more here.

4. Challenges with CMS’ Shift to Value-Based Payment

In an interview with The American Journal of Managed Care, Stuart Guterman, senior scholar in residence AcademyHealth, envisions the biggest challenge with adapting the model would be coming up with adequate measures of value. Having all the stakeholders to agree upon the right set of measures, he believes, is extremely important.

Listen to the interview here.

5. How Do Diverse Stakeholders Define Value in Oncology?

At the annual meeting of ASCO earlier this year, a patient representative, an oncologist, an ASCO representative, and a payer participated on a panel to discuss value from each stakeholder’s perspective. Lowell E. Schnipper, MD, introduced ASCO’s Value Framework tool that is currently under development, with plans to implement it at the doctor-patient interface. Neal J. Meropol, MD, from Case Western Reserve University School of Medicine, presented a clinician’s perspective based on his discussions with his patients. Patient concerns, Dr Meropol said, include the cost of traveling to the site of treatment, insurance coverage and co-payments, and denial of payment for recommended care. Jennifer Malin, MD, staff vice president of clinical strategy at Anthem Inc, introduced the payer approach to curbing costs and improving value, while Beverly E. Canin, Breast Cancer Options, Inc, lent the patient voice and emphasized the need for communication.

Read more here.