In this interview, Lalan Wilfong, MD, The US Oncology Network, shares insights from the Community Oncology Alliance’s 2024 Community Oncology Conference panel session titled "Defining Value in Oncology: Executing VBC Accurately & Ethically to Account for All Stakeholders."

Please share your name, title, and an overview of your professional history.

I am Dr Lalan Wilfong. I am senior vice president of Payer and Care Transformation for The US Oncology Network.

What were your key takeaways from the Community Oncology Conference session on defining value in oncology?

The key takeaways from the session on defining value in oncology were understanding who we define value for—whether it’s patients, practices, or payers—and trying to understand the benefits and risks of value-based arrangements for all of those different subgroups.

What major aspects of value do you believe are most important to consider when providing care to patients, and how does your practice prioritize these aspects?

When you're talking about value-based care, the most important thing to prioritize is patient care. Whenever we go into a value-based care arrangement, we want to make sure that the true heart of that is improving patient care and making sure that all of the payment models, quality metrics, and everything else goes toward improving that patient’s outcome and quality of life during the time we're under that model.

Any value-based care model must ensure patients get the right therapy. There's a term we use called stinting, and that means not giving patients appropriate therapy because you're not incentivized to do so. One of the challenges we face moving forward with value-based care is ensuring that these models never incentivize practices and physicians to not give the care that a patient needs. At the end of the day, we must follow national standard guidelines and treat patients appropriately, no matter the cost of the medicine, ensure that the right treatment for that patient at the right time.

How do you navigate the balance between delivering high-quality care to patients while also addressing the financial constraints often associated with value-based care models?

The balance between providing care to patients under value-based care and the financial constraints is a little tricky sometimes. In order to maintain viability, the practices have to be paid for the work they do. You can't add more staff and add more services without having revenue to support that. You have to make sure that the revenue that you're getting from a value-based care model justifies all of the work you're doing to provide better patient care. But at the end of the day, if you work it out correctly—and study after study has shown this—by providing active care navigation, meeting patients' social determinants of health needs, and helping them avoid financial toxicity with cancer care actually lowers the total cost of care and allows practices to perform well in value-based care models that are designed correctly.

Can you share any specific initiatives or strategies that your practice has implemented to improve value-based care delivery and outcomes for patients?

One of the biggest initiatives that The US Oncology Network has done this year to help provide better value for our patients is around social determinants of health (SDOH). We have 12 practices [participating] in the Enhancing Oncology Model (EOM), which requires SDOH screening for patients. We worked through the technology to have discrete data fields for these new questions that we were asking patients and worked on how to deliver this best to our patient population—whether it’s a paper form, a medical assistant or a nurse asking these questions, or an electronic [method] where they could receive these electronically and then report back in. We’ve done a lot of work and are still doing a lot of work on refining how to deliver this best to patients.

What I'm most excited about is that we've done significant work on helping to meet the needs of those patients. All Centers for Medicare & Medicaid Services (CMS) requires in EOM is to do SDOH screening, but it's challenging and really not appropriate for physicians and practices to ask questions where we can't figure out ways to help and direct patients to places that can help.

One of the things that we talk about a lot in the Network is how we can't solve every patient's problem. We can't solve the housing crisis in the US. I can't solve disparities based on zip codes. We're not going to be able to solve those [issues], but we can work with our community health partners to help link patients to community health partners that are working on those needs.

We invested in an organization called Findhelp—and there are a few others out there—that helps link patients with resources available in their communities. We've seen significant benefits of that across the network where we have a proactive approach of helping patients identify needs that they have and then linking them to community health resources to help them meet those needs.

There's a lot of work left to be done to make sure that adequate resources do exist for our patients because there are variabilities across the nation in terms of what resources are available to our patient populations. So, we need to do a lot of work to make sure that the community health resources in specific areas are adequate to meet our patient's needs. And then we need to figure out how to get ahead of it so that we are meeting patients’ needs even before they get a cancer diagnosis.

Again, that's going to require a multidisciplinary wide look at how we solve those problems. But at the end of the day, I'm passionate about this if you can't tell. We're doing what we can to help identify and meet patient's needs as part of that value-based care model.