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Dr Edward Licitra on Aligning Patient, Physician Goals in Value-Based Cancer Care


Edward Licitra, MD, PhD, medical oncologist, Astera Health Partners, discusses his thoughts on what value-based cancer care entails and how physicians can best align their goals with those of the patient and health plan.

Edward Licitra, MD, PhD, is a medical oncologist at Astera Health Partners.


As a medical oncologist, what aspects are top of mind when thinking about value-based oncology?

So, there's 3 major areas that we think are critically important if one truly wants to construct a high-value cancer care delivery model. The first is a community-based care delivery system of care. The second is patient-centric care and patient-centric services. And the third is precision medicine or personalized care. I'll talk a little bit about each one of those independently.

I think it goes without saying that when a patient is diagnosed with cancer, their entire world has changed, probably forever, but with that being said, we do have many treatments for cancer patients these days that will allow them to live lives for long periods of time that are quite productive.

So, the real challenge becomes how best do we incorporate the delivery of cancer care into their everyday life? So, how do we allow patients to continue to work? How do we allow patients to continue to care for their children or care for their parents? And how do we allow patients to get care close to home, because at the end of the day, their care is going to be delivered over a long period of time.

If we do our job right, we can figure out how we can properly integrate their cancer care program into their everyday life, such that they can continue to live the highest quality of life but yet receive treatments for their cancer for whatever period of time is necessary.

So, for that reason, we believe that providing care in the community close to home for patients is really critically important, because it allows them to balance all of the different variables that make their lives otherwise complicated in the sense that if we can deliver efficient, safe care within a community-based environment close to home, that will certainly add value to their cancer journey.

I think the second area that is really important is that when a cancer patient is diagnosed, I like to say that their life is spinning out of control. They really don't know what to expect, they don't know the details, they don't know what's ahead of them.

So, I think one of the really important things that we can do to create value for patients is to stop the chaos, restore order to the chaos, and ultimately create a system of care that is highly navigated, that communicates well with patients, that guides them through the entire process, such that we can restore order to an otherwise chaotic situation.

The third area is to provide care for a patient, which is the right care, at the right time, for the right duration of time.

What strategies can physicians employ to ensure that their value-based goals align with health plans and patients who may define value differently in cancer care?

Many people say that value is in the eye of the beholder, but I think there are 3 major strategies that all people can align around as it relates to value-based care in cancer. The first of those strategies is to improve patient outcomes, the second is to enhance the patient experience, and the third would be to control the cost of cancer care.

Any high-value cancer care delivery program really needs to put the patient at the center of the entire program. And I like to think of it as an ecosystem of care, where we put the patient in the middle, and we provide a portfolio of services that surround the patient. They surround the patient and what they strive to do is, number 1, improve their clinical outcomes. So what does that mean?

Improving the clinical outcome could be everything from providing efficient access to care, providing the proper care, but also providing care where we minimize toxicity or we minimize the side effects of cancer and manage them appropriately. So, if we do all of those things, I think we have a good chance at really improving the clinical outcomes for cancer patients.

I think secondarily, in terms of improving the patient experience, what I like to think of it as is when patients are diagnosed with cancer, part of our job is to really decrease the emotional toxicity of cancer. Cancer is scary, and people really want to receive care efficiently. And part of the process is that the process is inefficient.

So, if we have the ability to precisely coordinate and navigate their care, such that we have the ability to decrease the anxiety that they may have by delivering care in an efficient manner, I think that really enhances the patient experience.

The third aspect is to deliver care in a manner which is under control of the cost. So, cancer care can be expensive and it can also be expensive for patients who have large deductibles or out of pockets. So, a value-based system of care in my opinion really needs to assist the patient in figuring out how they can best afford the cost of their cancer care by coordinating their financial benefits, by providing financial guidance, and by looking for various sources of financial assistance and support for patients either from independent foundations or from pharmaceutical companies.

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