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Panchal R, Brendle M, Ilham S, Kharat A, Schmutz HW, Huggar D, McBride A, Copher R, Au T, Willis C, Brixner D. The implementation of value-based frameworks, clinical care pathways, and alternative payment models for cancer care in the United States. J Manag Care Spec Pharm 2023; 29:999-1008. [PMID: 37321967 PMCID: PMC10510672 DOI: 10.18553/jmcp.2023.22352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND: Cancer treatment is a significant driver of rising health care costs in the United States, where the annual cost of cancer care is estimated to reach $246 billion in 2030. As a result, cancer centers are considering moving away from fee-for-service models and transitioning to value-based care models, including value-based frameworks (VBFs), clinical care pathways (CCPs), and alternative payment models (APMs). OBJECTIVE: To assess the barriers and motivations for using value-based care models from the perspectives of physicians and quality officers (QOs) at US cancer centers. METHODS: Sites were recruited from cancer centers in the Midwest, Northeast, South, and West regions in a 15/15/20/10 relative distribution. Cancer centers were identified based on prior research relationships and known participation in the Oncology Care Model or other APMs. Based on a literature search, multiple choice and open-ended questions were developed for the survey. A link to the survey was emailed to hematologists/oncologists and QOs at academic and community cancer centers from August to November 2020. Results were summarized using descriptive statistics. RESULTS: A total of 136 sites were contacted; 28 (21%) centers returned completed surveys, which were included in the final analysis. 45 surveys (23 from community centers, 22 from academic centers) were completed: 59% (26/44), 76% (34/45), and 67% (30/45) of physicians/QOs respondents had used or implemented a VBF, CCP, and APM, respectively. The top motivator for VBF use was "producing real-world data for providers, payers, and patients" (50% [13/26]). Among those not using CCPs, the most common barrier was a "lack of consensus on pathway choices" (64% [7/11]). For APMs, the most common difficulty was that "innovations in health care services and therapies must be adopted at the site's own financial risk" (27% [8/30]). CONCLUSIONS: The ability to measure improvements in cancer health outcomes was a large motivator for implementing value-based models. However, heterogeneity in practice size, limited resources, and potential increase in costs were possible barriers to implementation. Payers need to be willing to negotiate with cancer centers and providers to implement the payment model that will most benefit patients. The future integration of VBFs, CCPs, and APMs will depend on reducing the complexity and burden of implementation. DISCLOSURES :Dr Panchal was affiliated with the University of Utah at the time this study was conducted and discloses current employment with ZS. Dr McBride discloses employment with Bristol Myers Squibb. Dr Huggar and Dr Copher report employment, stock, and other ownership interests in Bristol Myers Squibb. The other authors have no competing interests to disclose. This study was funded by an unrestricted research grant from Bristol Myers Squibb to the University of Utah.
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Affiliation(s)
- Rupesh Panchal
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
- University of Utah Health Plans, Murray
| | - Madeline Brendle
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Sabrina Ilham
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Aditi Kharat
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Howard W. Schmutz
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | | | | | | | - Trang Au
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Connor Willis
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Diana Brixner
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
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Hoda D, Richards R, Faber EA, Deol A, Hunter BD, Weber E, DiFilippo H, Henderson-Clark T, Meaux L, Crivera C, Riccobono C, Garrett A, Jackson CC, Fowler J, Theocharous P, Stewart R, Lorden AL, Porter DL, Berger A. Process, resource and success factors associated with chimeric antigen receptor T-cell therapy for multiple myeloma. Future Oncol 2022; 18:2415-2431. [PMID: 35583358 DOI: 10.2217/fon-2022-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Chimeric antigen receptor T-cell (CAR-T) therapy represents a new frontier in multiple myeloma. It is important to understand critical success factors (CSFs) that may optimize its use in this therapeutic area. Methods: We estimated the CAR-T process using time-driven activity-based costing. Information was obtained through interviews at four US oncology centers and with payer representatives, and through publicly available data. Results: The CAR-T process comprises 13 steps which take 177 days; it was estimated to include 46 professionals and ten care settings. CSFs included proactive collaboration, streamlined reimbursement and CAR-T administration in alternative settings when possible. Implementing CSFs may reduce episode time and costs by 14.4 and 13.2%, respectively. Conclusion: Our research provides a blueprint for improving efficiencies in CAR-T therapy, thereby increasing its sustainability for multiple myeloma.
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Affiliation(s)
- Daanish Hoda
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Robert Richards
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward A Faber
- Transplant & Cellular Therapy Program, Oncology/Hematology Care, USA.,Adult BMT & Cellular Therapy Program, University of Cincinnati, 2600 Clifton Ave, Cincinnati, OH 45221, USA
| | - Abhinav Deol
- Karmanos Cancer Center, 4100 John R St, Detroit, MI 48201, USA
| | | | - Elizabeth Weber
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Heather DiFilippo
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Linda Meaux
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Concetta Crivera
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Carrie Riccobono
- US Medical Affairs, Legend Biotech, 2101 Cottontail Lane Somerset, NJ 08873, USA
| | - Ashraf Garrett
- US Medical Affairs, Legend Biotech, 2101 Cottontail Lane Somerset, NJ 08873, USA
| | - Carolyn C Jackson
- Janssen Pharmaceutical Research & Development, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Jessica Fowler
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | | | - Raj Stewart
- Evidera
- PPD, 7101 Wisconsin AvenueSuite 1400Bethesda, MD 20814, USA
| | - Andrea L Lorden
- Evidera
- PPD, 7101 Wisconsin AvenueSuite 1400Bethesda, MD 20814, USA
| | - David L Porter
- Cell Therapy & Transplant Program, Division of Hematology-Oncology & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ariel Berger
- Evidera
- PPD, 7101 Wisconsin AvenueSuite 1400Bethesda, MD 20814, USA
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Yang Z, Ganguli I, Davis C, Dai M, Shuemaker J, Peterson L, Bazemore A, Phillips R, Chung YK. Physician versus Practice-Level Primary Care Continuity and Association with Outcomes in Medicare Beneficiaries. Health Serv Res 2022; 57:914-929. [PMID: 35522231 PMCID: PMC9264477 DOI: 10.1111/1475-6773.13999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare physician versus practice-level primary care continuity and their association with expenditure and acute care utilization among Medicare beneficiaries and evaluate if continuity of outpatient primary care at either/both physician or/and practice level could be useful quality measures. DATA SOURCE Medicare Fee-For-Service claims data for community dwelling beneficiaries without End-Stage Renal Disease who were attributed to a national random sample of primary care practices billing Medicare (2011-2017). STUDY DESIGN Retrospective secondary data analysis at per Medicare beneficiary per year level. We used multivariable linear regression with practice-level fixed effects to estimate continuity of care score at physician vs. practice level and their associations with outcomes. DATA COLLECTION/EXTRACTION METHOD We calculated clinician and practice level Bice-Boxerman continuity of care index scores, ranging from 0 to 1, using primary care outpatient claims. Medicare expenditures, hospital admissions, emergency department visits, and readmissions were obtained from the Medicare Beneficiary Summary File: Cost and Utilization Segment. Ambulatory care sensitive conditions (ACSC) were defined using diagnosis codes on inpatient claims. PRINCIPAL FINDINGS We studied 2,359,400 beneficiaries who sought care from 13,926 physicians. Every 0.1 increase in physician continuity score was associated with a $151 reduction in expenditures per beneficiary per year (P<0.01), and every 0.1 increase in practice continuity score was associated with $282 decrease (P<0.01) per beneficiary per year. Both physician- and practice-level continuity were associated with lower Medicare expenditures among small, medium, and large practices. Both physician- and practice-level continuity were associated with lower probabilities of hospitalization, emergency department visit, admissions for ACSC, and readmission. CONCLUSIONS Primary care continuity of care could serve as a potent value-based care quality metric. Physician-level continuity is a unique value center that cannot be supplanted by practice level continuity.
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Affiliation(s)
- Zhou Yang
- Omada Health, 500 Sansome St #200, San Francisco, CA
| | - Ishani Ganguli
- Brigham and Women's Hospital, Medicine, 1620 Tremont Street BC3-2M, Boston, MA
| | - Caitlin Davis
- Inova Fairfax Family Medicine, Residency Program, Fairfax, VA
| | - Mingliang Dai
- American Board of Family Medicine, 1648 McGrathiana Parkway Lexington, KY
| | - Jill Shuemaker
- The Center for Professionalism and Value in Health Care, 1016 16th Street NW Suite 700, Washington, DC
| | - Lars Peterson
- American Board of Family Medicine, 1648 McGrathiana Parkway Lexington, KY
| | - Andrew Bazemore
- The Center for Professionalism and Value in Health Care, 1016 16th Street NW Suite 700, Washington, DC
| | - Robert Phillips
- The Center for Professionalism and Value in Health Care, 1016 16th Street NW Suite 700, Washington, DC
| | - Yoon Kyung Chung
- The Robert Graham Center, 1133 Connecticut Avenue, NW Suite 1100, Washington, DC
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Boriani G, Vitolo M, Svennberg E, Casado-Arroyo R, Merino JL, Leclercq C. Performance-based risk-sharing arrangements for devices and procedures in cardiac electrophysiology: an innovative perspective. Europace 2022; 24:1541-1547. [PMID: 35531864 DOI: 10.1093/europace/euac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
There is an increasing pressure on demonstrating the value of medical interventions and medical technologies resulting in the proposal of new approaches for implementation in the daily practice of innovative treatments that might carry a substantial cost. While originally mainly adopted by pharmaceutical companies, in recent years medical technology companies have initiated novel value-based arrangements for using medical devices, in the form of 'outcomes-based contracts', 'performance-based contracts', or 'risk-sharing agreements'. These are all characterized by linking coverage, reimbursement, or payment for the innovative treatment to the attainment of pre-specified clinical outcomes. Risk-sharing agreements have been promoted also in the field of electrophysiology and offer the possibility to demonstrate the value of specific innovative technologies proposed in this rapidly advancing field, while relieving hospitals from taking on the whole financial risk themselves. Physicians deeply involved in the field of devices and technologies for arrhythmia management and invasive electrophysiology need to be prepared for involvement as stakeholders. This may imply engagement in the evaluation of risk-sharing agreements and specifically, in the process of assessment of technology performances or patient outcomes. Scientific Associations may have an important role in promoting the basis for value-based assessments, in promoting educational initiatives to help assess the determinants of the learning curve for innovative treatments, and in promoting large-scale registries for a precise assessment of patient outcomes and of specific technologies' performance.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,EHRA mHEALTH and Health Economics Section, European Heart Rhythm Association, Biot, France
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Josè L Merino
- Arrhythmia & Robotic EP Unit, University Hospital La Paz, Autonoma University, IdiPaz, Clinica Viamed-Santa Elena, Madrid, Spain
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Affiliation(s)
- Greg J Zahner
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Peter W Croughan
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Daniel M Blumenthal
- Cardiology Division, Massachusetts General Hospital, Boston
- Novocardia, Boston, Massachusetts
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