Day 2 of the Oncology Clinical Pathways Congress (October16-18) was filled with presentations from pathways experts well-versed in value-based payment models.
This multi-part series presented examples of current value-based care programs and practical strategies to achieve greater value in care delivery. Various stakeholders provided their definitions of “value,” with perspectives from the employer, payer, provider, and pathway vendor represented.
Featured speakers included Magda Rusinowski, Vice President of the Business Group on Health, who provided the employers perspective on this topic. This group is the only nonprofit organization devoted exclusively to representing large employers’ perspective on health policy issues and optimizing workforce strategy through innovative health, benefits, and well-being solutions. Ms Rusinowski leads the Cost & Delivery Institute, focused on health care cost trends, delivery system transformation, evidence-based benefits design, and pharmacy strategy. She highlighted trends in employer provider coverage relevant to oncology care and discussed strategic tools utilized by self-insured employers to steer members to the right care for the right cost.
Representing the pathway vendor perspective was Sonali Fonseca, PhD, VP Oncology Pathways & Programs at Elsevier, where she oversees their pathways program ClinicalPath (formerly Via Oncology). ClinicalPath is widely used and was awarded the MedTech Breakthrough Award for Best Computerized Decision Support Solution for 2 consecutive years. In her role, Dr Sonali engages frequently with many oncology practices across the country, and she brought these experiences to bear, demonstrating how pathways are an important tool to participate in value-based models in a predictable and sustainable manner.
Marcus Neubauer, MD, CMO of The US Oncology Network (USON), shared how USON generates clinical pathways content. Created 25 years ago, USON is an integrated cancer care organization that includes 1200 affiliated physicians, ~20% of whom are in the Oncology Care Model. Since 2013, they have used Value Pathways Powered by NCCN, created in collaboration with NCCN. The pathways are brought to providers at the point of care through the clinical decision-support tool called Clear Value Plus. All practices within USON work within the same unified electronic medical record, which allows many opportunities to share and integrate knowledge and tools, especially in collecting and analyzing practice and patient data. They can track provider-level compliance and outcomes across USON and bring such data to payers for use in value-based reimbursement agreements.
Other presenters included Ray Page, DO, PhD, FACOI, FASCO, President & Director of Research, The Center for Cancer and Blood Disorders, University of North Texas Health Science Center, and Sibel Blau, MD, President/CEO of Quality Cancer Care Alliance Network, and Medical Director, Northwest Medical Specialties. Together, Dr Page and Dr Blau discussed the utility of symptom management pathways to avoid hospitalizations and emergency room visits. They also underscored the need for providers and payers to collaborate on developing value-based care plans by using big data tools.
A former practicing oncologist, Andrew Hertler, MD, FACP, CMO, New Century Health, is responsible for the company’s clinical, quality, and value-based strategy, utilization management policies, and leadership initiatives. Founded in 2002, New Century Health is a national specialty care leader in managing specialty care under risk-based, capitated relationships. Dr Hertler discussed the need for financial alignment of physicians with value-based care to support pathway utilization and outlined the components of the ideal alternative physician payment model. He noted the critical importance of working with a practice leader committed to value-based care and specifically presented 2 examples of value-based alternative payment models (developed at New Century Health). They use proprietary clinical pathways to managing risk.
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