Steven Peskin, MD, MBA, FACP provides an understanding of value-based care vs cost for therapy.
Bruce Feinberg, DO: Steve, It’s unfortunate that when we bring up value-based care, it introduces the notion of cost because that really was the change; it was not just efficacy and toxicity as a measure in cancer care, it was cost. Certainly, it often means a finger gets pointed toward the payer, who is the steward of the health care dollar, and I find that to be very unfair in many ways. As Joyce clearly said, every stakeholder has an issue in this. But I want to give you the last word because it feels sometimes that the payer gets put in a negative light.
Steven Peskin, MD, MBA, FACP: So there are 4 components, and you asked Bill about it and Joyce opined on it as well. There’s clinical effectiveness or outcomes. There is affordability, which is the cost; there’s the Kelli part of it, the patient experience, the patient journey—I would refer you to the great book, The Cost of Hope, and 2 masters prepared people and Terry, who had 6 ½ years of cancer and eventually died, and the Pulitzer Prize—winning writer, his wife—so there’s the patient journey and patient education. Then there’s health care professional sustainability—so bringing back joy into the practice of medicine. There are 4 things: clinical outcomes, affordability, patient experience, and I’m not putting them in any order, and then health care professional sustainability. As we work toward value-based frameworks to unshackle Bill and Joyce and others with respect to some of the more onerous administrative burden, it’s looking to our clinical partners to make responsible decisions in being stewards of not unlimited dollars. It was either Bill or Joyce who mentioned PET [positron emission tomography] CT. I remember speaking at a conference years ago where a surgeon was kind of being a bit harsh to some of his medical oncology colleagues about unnecessarily ordering PET CTs on patients with stable breast cancer. Again, I’m not a judge of that, I’m not a medical oncologist, I’m not a surgical oncologist, I’m not a radiologist, so I would defer to others much more nuanced than myself. But it was a point that a surgeon made to me related to some of his medical colleagues. There’s a lot of costs that may be taken out for the 30% that the National Academy of Medicine, formerly called the Institute of Medicine, talks about that’s unnecessary care, and then folks like Kelli have less patient cost burden if we’re responsible.