Early Learnings From Innovators in the Pursuit of Value-Based Care

Making the transition from fee-for-service reimbursement to value-based models of care and payments will be slow and difficult. As the initial concepts behind value-based reimbursement and care delivery models materialize into concrete strategies for change, oncology care practices would benefit from widening channels of communication between stakeholders to share their experiences with innovative approaches. Long-term data and outcomes will not yet be available in such early days of trial and error, and the problem-solving tactics of those spearheading new processes can serve to maintain forward progress in the uphill battle. 

The Center for Medicare & Medicaid Innovation’s (CMMI) Oncology Care Model (OCM) was officially launched on July 1, 2016, and preliminary results from the first reporting period are just now being analyzed by CMMI. Practices participating in the pilot are also starting to compile data and determine next steps, but providers are already starting to learn from initial barriers to implementation. Clearview Cancer Institute (CCI), a private, physician-owned community practice serving hematology and oncology patients, became aware of the OCM program in early 2015 and decided to apply. In her article, Anne Marie Fraley Rainey, MSN, RN, CHC, describes CCI’s experience in preparing for OCM participation, including identification of care delivery areas in need of alterations or new programming, how these enhancements were achieved, and challenges encountered throughout the process with the aim of aiding other practices on the same journey (page 40). 

The Levine Cancer Institute (LCI) is one of those practices on a similar journey toward standardized yet individualized care delivery. In 2015, LCI created an electronic clinical pathways tool, Electronically Accessible Pathways (EAPathways), with the purpose of providing evidence-based, continually updated clinical pathways for all LCI network providers (page 52). Kathryn E Patronik, MHA, and Edward S Kim, MD, FACP, discuss how the EAPathways are helping LCI standardize care, provide access to patient services and clinical trials, promote specialized care by local providers, and deliver care in a similar manner across their regional network thus far.

Finally, directing attention to reimbursement issues related to new care models, this issue’s Pharma Insights column addresses value-based contracting. In addition to the increased focus on value in arrangements between payers and providers, interest in value-based contracting between payers and pharmaceutical manufacturers is likewise on the rise. Maylou Buyse, MD, and coauthors explain how value-based agreements can also benefit the manufacturer who, while facing some downside risk, achieves greater access than could otherwise be attained (page 27). The shared risk can take the form of payments based on outcomes or clinical measures, indication-specific pricing, or shared cost risk.