Review of Value-Based Frameworks Reveals Gaps Between Payer, Patient Goals

A recent presentation at the 2016 San Antonio Breast Cancer Symposium, entitled “Value of Cancer Care for Metastatic Breast Cancer Patients and Providers,” found that goals in value-based frameworks for breast cancer patients are not completely aligned between patients and payers. 

“The landscape of treatment options and associated prognosis for patients with metastatic breast cancer is rapidly evolving,” Dana P Goldman, PhD, professor and the Norman Topping chair in medicine and public policy at the University of Southern California, and colleagues, wrote. “In response to these advances in therapy, numerous organizations have invested considerable resources into developing evaluation frameworks seeking to clarify the value of new therapies. While some of these frameworks foster patient-provider shared decision-making, others are more payer focused, and all are limited in their incorporation of patient perceptions of value and evidence on treatment aspects most meaningful to patients.”

In order to identify which attributes of treatment patients value most, and compare those findings to payer values, the researchers conducted four 90-minute focus groups. They included two groups of breast cancer patients and two groups with breast cancer health care providers. Discussions were assessed using thematic analysis. 

The researchers found that the most important goals among patients included impact of treatment side effects on their daily lives, depth of treatment response, longevity of life, and the value of hope in conquering their cancer and achieving survival. In comparison, providers revealed that the goals most important to them were clinical-based. The researchers noted that these findings revealed a gap in the value of emotional and psychological factors. They suggested that frameworks be revisited to incorporate these values. 

“This analysis reveals that while patient and healthcare provider assessments of value in treating metastatic breast cancer are well-aligned with respect to clinical factors such as managing side effects and depth of treatment response; patients also prioritize emotional and psychological factors—like having hope and avoiding suffering—in addition to clinical factors,” Dr Goldman and colleagues concluded. “Moving forward, patient-centered value frameworks for metastatic breast cancer will need to address this gap between what providers and payers value and patient goals and priorities.” —David Costill