Barry Russo, MBA, the Center for Cancer and Blood Disorders, spoke with the Journal of Clinical Pathways at the 2024 Community Oncology Conference about his session titled “Defining Value in Oncology: Executing VBC Accurately & Ethically to Account for All Stakeholders.”

Please share a little about your affiliation and background.

I'm Barry Russo. I'm the CEO for the Center for Cancer and Blood Disorders in Dallas, Fort Worth, Texas.

As the CEO of a community oncology practice, what does “value-based care” mean to you, and how do you ensure it is executed accurately and ethically within your organization?

Value-based care to our practice means population management. It means taking care of a whole person and understanding that that's what's involved in cancer care. It means managing costs as well as coordination of care. To manage that, we surround the patient with a team of people. It takes a village to take care of a cancer patient, and to ensure that there's no ethical concerns associated with that, we monitor and follow National Comprehensive Cancer Network (NCCN) guidelines.

We have a pathway system that we use to monitor compliance to ensure that we're always providing state-of-the-art care while managing costs for the patient and coordinating care. What we find is when we coordinate care, we're actually managing costs.

We're finding gaps and places where we could do a better job of pulling the pieces together for the patient. Managing cost isn't about reducing care. It's about managing and coordinating care and using pathways and guidelines to ensure you're following the national standards for care for patients.

In the session titled “Defining Value in Oncology,” what key aspects of value do you believe are most important to consider when providing care to patients, and how does your practice prioritize these aspects?

The most important part of the care process—when working with a patient in a value-based environment—is recognizing that we have to manage the whole person. We're not there just to cure cancer, we're there to heal lives. But that takes a lot of different components of support, whether it's psychosocial support or the treatment that we're providing. It's important that value-based care has a good definition because it ensures that we're focused on the whole life of the patient.

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?

It's a balancing act. We have to use a lot of support around us. Sometimes that's foundations, sometimes it's the primary care physician, sometimes it's a patient’s pulmonologist. We have to use every resource available to us to balance the cost pieces as well as the care pieces. It may be as simple as our navigator and what our navigator can do to help with transportation or food or other social determinants of health issues.

These days there is a focus on social determinants of health. That's been a part of cancer care for decades and what we've been dealing with and managing for a long time. It takes a village and there are a lot of pieces you have to work with outside of your organization. For example, resources such as foundations, social services, and brokers can help people get on insurance plans when they've lost insurance because of disability. It takes all of that to make value-based care work.

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

We started initially by centralizing our triage and symptom management function. Doing so allowed our nurses to focus on symptom management and helping the patient, keeping them out of the emergency room and keeping them out of the hospital. That was all on a phone call basis and it was more reactive, meaning that when the patient didn't feel well, there was a place to call and we could help manage that.

This evolved to a more proactive process where we have a bot that reaches out to the patient and asks them how they're feeling, if they're having any issues of nausea, vomiting, or pain, etc. And if they do and they respond to the bot, the bot can then direct the call to nurses or advanced practitioners to step in if the patient is having complications.

But we're catching it sooner and we're catching it better because we're more proactive in the process. We're sending communication to the patient twice a week electronically to see how they're feeling and what they're doing. This allows us to do more for more patients and in a timely basis. It has really made a difference in our process. We are also working with many patients, families, and caregivers to help patients through their journey. It's been a huge help in keeping people on therapy.

Lastly, one of the most important things we've started is our internal palliative care service. We have a board-certified palliative care physician and an advanced practitioner that assists her, which has made a huge difference in helping patients with pain management. It has also made a huge difference for the patients that have to transition from active care to potentially hospice or comfort care. It makes the journey a whole lot easier if that's the outcome of your journey.

Considering the diverse range of stakeholders involved in oncology care, how do you ensure that all parties, including patients, providers, payers, and the broader community are accounted for?

How we ensure everyone who is involved—all boats rise—is by focusing on the patient and the needs of the patient. If you identify the needs beyond just treatment, including other supportive needs and psychosocial needs, you can keep the patient on therapy and keep the process moving for the patient. If you focus on the patient, everyone else that's involved in the process—whether it's the payer, their primary care physician, their caregiver, or any of the above—if you focus on the healing and the life of the patient all parties involved in the journey will benefit and succeed.