Continued innovations in oncology hold the promise of survival improvements. However, new treatments introduce significant challenges for patients, such as higher out-of-pocket expenses and new toxicities. Likewise, wasteful clinical care leads to significant inefficiency in the US health care system. The shift to value-based care models is a signal of an inflection-point in the health care ecosystem. The articles in this issue center on complex procedures to examine where resource utilization may be reduced and how value frameworks still need to evolve to better support patients and increase the value of care.
Hematopoietic stem cell transplant (HSCT) for blood and bone marrow disorders is a costly procedure that requires complex treatment regimens. In addition to disease-related factors, comorbidity, psychosocial characteristics, variations in health insurance, adherence to therapy, and availability of a care partner can affect transplant outcomes and cost of care. Yordanka N Koleva, PhD, and colleagues conducted a retrospective study to examine the impact of patients’ psychosocial and health insurance status, among other clinical factors, on post-stem cell transplant health services utilization. Authors found that consideration of patients’ psychosocial factors, availability of a care partner, and health insurance status may help estimate post-HSCT health care cost related to hospital admissions and length of stay.
The high costs of novel anticancer medications have placed considerable financial pressure on both the US health care system and on patients. Many leading organizations have created value frameworks to help assess treatment options and their relative value. Leading oncology organizations like the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have created their own value frameworks, but many think that patient preferences are not adequately integrated into these frameworks and that the metrics they employ do not produce reliable information. Jalpa A Doshi, PhD, and colleagues review current ASCO and NCCN value frameworks and discuss how they still need to evolve to meet the needs of patients and the shift to value-based care delivery and reimbursement.
Low-value health care—treatment and testing that exposes patients to costs, harms, and risks that outweigh any benefits conferred based on the clinical situation—puts substantial strain on the health care system. Frameworks exist to manage low-value health care, yet it continues to defy systematic resolution. In his column, Ira Klein, MD, MBA, FACP, reviews current efforts within the US health care system that have made meaningful changes in hospital processes, explaining how clinical pathways endeavors are essential for continued progress. There is too much economic and political pressure for employers not to reassess their employee health benefits design and too much scientific evidence to not utilize pathway and step approaches to eliminate low-value care.
