How Collaborative, Value-based Care Oncology Solutions Can Improve Patient Outcomes

It is hard to find anyone in this country whose life hasn’t been affected by cancer – either directly or when someone they know has been stricken with the disease. The numbers are staggering – more than 2 million new cancer cases projected for 2025 in the U.S. and costs for cancer care estimated to amount to $246 billion in 2030. The question is: how do we tackle this escalating challenge? Many leading healthcare organizations are prioritizing value-based care, both reducing the cost burden while importantly improving patient outcomes.

To explore how HLC members are successfully employing this approach, HLC President and CEO Maria Ghazal moderated a panel during the 4th Virtual Value-based Payment Summit, “Delivering Breakthrough Therapies Through Value-Based Care and Multiple-Sector Partnerships.” Featuring Harlan Levine, MD, of City of Hope; Chris Mancill, MA, of AstraZeneca; and Martha L. Wofford, MBA, of Blue Cross Blue Shield of Rhode Island, the panel explored collaborative value-based payment initiatives for oncology treatments.

Below are main takeaways from the event*:

Value-based care models can improve oncology treatments and the patient experience across multiple healthcare sectors

As all sectors of the healthcare system work to increase efficiency and improve patient outcomes, “value-based care” is defined and thought of in many different ways. Wofford explained that when it comes to her company, “We’re investing in specialty, value-based care models. Rhode Island is unique. We have 1.1 million people in a really small geography, and that high density makes us a great test bed for different innovative approaches. [Also,] we have an incredibly close collaborative relationship with our health system partners [given] our proximity to other health care markets, Boston, New Haven, New York City, and being a PPO market means that a lot of care happens outside of our borders.”

Dr. Levine explained that from his organization’s perspective, “Value-based care is essential to the future. When you’re a patient with cancer, you care about survival, the quality of your life, and the patient experience. [At] City of Hope, we’ve taken the position of wanting to be the industry spokesperson, advocating on behalf of the patient. So, while we need to optimize the cost, we also should deliver what all of us would want if we had cancer, which is accurate diagnosis with genomic testing, leading edge therapies with access to clinical trials, and holistic patient care.”

Collaboration across healthcare sectors is vital, with creative solutions enabling the employment of value-based care

With a variety of geographic footprints represented on the panel, Ghazal asked the panelists to explain their value-based care approaches. Wofford shared, “Our new group purchasing organization called Synergie Medication Collective, [will] use the Collective’s scale of the Blues to purchase drugs more efficiently. [Through this,] we’re enabling access to cutting-edge [cell and gene] therapies at centers of excellence and then, to ensure that the therapy is actually effective, We’re entering into value-based care arrangements [with manufacturers] where there’s an ability to recoup some of the cost of the therapy if it doesn’t end up being curative … Cancer care is an example of very volatile spending, so the ability to pool risk more broadly is important to secure access.”

Mancill similarly discussed the importance of collaboration across sector partners, stating, “As we look at the ways to align the system to be able to lead to the best outcomes for patients, there needs to be incentives at every level. [Further,] we work all across the country, but we see a lot of variety. When we talk to maybe one payer, we think we’ve come up with a really good, innovative approach. Then, we take that same model and try to lift and shift to another one, it might not work. [A] lesson of looking at a geography as large as the United States is that you have to think big but you really have to know the local markets to be able to execute value-based care effectively.”

The future of value-based care is bright, and advancing artificial intelligence (AI) can help realize its potential

In closing the panel, Ghazal asked for predictions for the future of value-based care in the oncology space. Mancill responded, “Rather than having value-based approaches for new drug launches be rare, I think they will become more commonplace. So, for every new launch, especially in oncology, we’ll see a novel approach, a different way of thinking about bringing that innovation to the patient in a new way, with incentives around for all that will become much more commonplace.”

Ghazal raised how the rapidly advancing abilities of artificial intelligence (AI) could impact this field, to which Dr. Levine said, “I’m putting some wild guesses out there … in three years, AI will be used widely to support pathology and radiology, not replace the doctor. In five years, we’ll be using it for clinical decisions on a regular basis, again not to supplant the doctor. Then in 10 years, we’ll be using AI to study the data and do precision early detection, so we know who needs screening for cancer [and] we can really get at that problem of early detection.”

Value-based care is a key priority for HLC and its members, given its focus on quality of care, emphasizing care coordination, and the whole patient. Especially for oncology, given cancers can be chronic illnesses, these approaches can reprieve patients from fragmented services, and help healthcare systems deliver better patient outcomes. You can learn more about HLC’s efforts to advance value-based care here. Watch the full panel recording here.

Please note: some quotes have been edited for brevity.