Cancer is among the most frightening diagnoses for patients to receive.
It is a daunting challenge for oncology treatment specialists, and a persistent challenge for policy makers, payers, and other parties charged with ensuring that high-quality, evidence-based, cost-effective care is delivered consistently for all patients.
In addition to the physical manifestations of oncologic disease and the often very difficult treatment side-effects, many patients experience significant financial distress as a result of their diagnosis and treatment.
Patients are also often left to navigate a complex and unclear labyrinth of healthcare services on their own during a period of intense physical and emotional vulnerability—the disjointed care that is one of the most unfortunate results of the prevailing fee for service payment methodology.
In an attempt to address these issues, many experts are evaluating the potential for adoption of value-based, collaborative care payment models such as Episodes of Care/Bundled Payments as an alternative to fee for service.
Value-based models are intended to improve patient outcomes and experiences.
They are also intended to reduce the overall cost of care by shifting focus from each unit of care rendered by every independent practitioner, also known as fee for service, to the comprehensive care rendered to each patient, across a full spectrum of providers.
The goal is to use a collaborative, multidisciplinary care model of providers who work to design practice guidelines and evidence-based algorithms that will reduce variation and optimize care, patient experiences and overall costs of care.
Success requires that all stakeholders involved, such as providers, payers and others, communicate and agree to their respective roles in delivering seamless, optimal care.
Developing value-based reimbursement models to support patients with cancer is significantly more complicated than for other kinds of healthcare episodes or conditions.
Unlike patients who are having surgical procedures which typically are one-time procedures with discrete triggering events, patients with cancer have wide variability in disease state and progression, significant differences in treatment options and outcomes and varying start and end points of treatment.
Despite these complexities, it is possible to design effective models.
Like any other episode of care model, it needs to be structured to clearly define which criteria qualify a patient to be in the episode of care, what services are included in the model and what the start and end points are for the episode.
Related: Trends in Value-based Care