How can value-based care in oncology improve cancer care?

What is value-based healthcare?

Value-based healthcare highlights the importance of emphasizing health outcomes of treatment relative to its costs and is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes and steps away from quantity treatments to make money (that are not needed). Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.

Michael Porter is the Pioneer and he proposed first model with 6 pillars, that now are used as base to develop different types of models in the USA and elsewhere:

• Organize into Integrated Practice Units,
• Measure outcomes and costs for every patient,
• Move to bundled payment for care cycles,
• Integrate care delivery across separate facilities,
• Expand excellent services across geography, and
• Build an enabling information technology platform.

What are the challenges linked to value-based healthcare in oncology?

While the term ‘value-based’ has now been around for several years, challenges to integrate value-based structures into the provision of care, specifically in chronic conditions such as oncology, remain. This is because of 2 main reasons

A Lack of a consensus over how to define and measure “value”

Healthcare providers are somewhat free to translate “value” into measures subjectively, yet, the often uncoordinated care and lack of necessary and systematic data to measure health outcomes have made the consensus on value difficult. In addition, it is hard to get consensus on how it shall be measured. It remains to be proven if all measures improve quality of care and life equally.

A complexity of many indications, eg oncological cases

Cancer patients have wide variability in disease and progression states, various treatment options, different points of beginning and end of treatment, and usually require a multidisciplinary approach to their care. Hence, there are several points within the care pathway where ‘value’ can be defined and measured, as well as different elements of health outcomes – short and long term, as well as the patient experience itself.

Find out more about how our team can support you in your projects related to value-based healthcare >

How can we achieve patient-centric VBHC in oncology?

To achieve patient-centric value-based healthcare (VBHC), two critical factors come into play: patient centricity and value-based reimbursement models.

Through patient centricity

Patient centricity emphasizes the importance of tailoring healthcare to the unique circumstances and preferences of each patient. The aim is to provide comprehensive and integrated care that not only enhances patient health outcomes but also improves their overall treatment experience and quality of life.

Through value-based reimbursement

On the other hand, value-based reimbursement models focus on costs and bring in new perspectives on reimbursement and the financial responsibilities of stakeholders, such as care providers and payers. The objective is to incentivize and foster collaboration among all parties involved in healthcare delivery to align on improving patient outcomes while also managing costs and risks.

How is the situation around Value Based Healthcare in the USA and Germany?

VBHC in the USA

Compared to other countries worldwide, the United States has the highest number of value-based reimbursement initiatives, with the affordable care act driving the push towards value-based healthcare. Approximately 90% of physicians in the US use electronic health records (EHR), which are a crucial tool for reporting performance and quality measures. Primary care physicians use EHRs to bill and report on quality measures that vary depending on the program they are participating in, but navigating through the numerous programs, measures, and EHR functionalities can be challenging for healthcare providers. The motivation for physicians to participate in quality programs varies depending on their individual profile, but once a system is in place, it can be challenging to leave.

VBHC in Germany

In the German healthcare system, quality of care is the primary driver, and the country is making promising strides towards patient-centric value-based care. For instance, quality is taken into account in drug reimbursement and through diagnosis-related group (DRG) coding, which emphasizes quality treatments over quantity. However, the healthcare system still has significant inequalities in care provision, particularly in terms of access to care and the quality of care. One example of how Germany is moving towards patient-centric value-based healthcare is the certification program for cancer centers that must meet specific quality standards. This program is currently underway and aims to consolidate care in expert centers.

The Martini Clinic: a key example of how to optimize cancer care through Value Based Care

An example of a certified center, with a unique certification, is the Martini clinic located in Hamburg. This certification is considered a PLUS because the entire clinic focuses exclusively on one medical condition, which is prostate cancer. The care system has been meticulously optimized to achieve the highest possible outcomes for this specific condition. The clinic has established guiding principles to achieve these exceptional outcomes, which include:

• super-specialization
• rigorous measurement of patient-reported outcomes over many years
• a commitment to using state-of-the-art technology,
• a team-based professional structure that values learning and collaboration over competition and hierarchies
• incentives in place for outcomes and team cohesion with all staff receiving the same salary with pooled bonuses that reward reaching quality targets and total scientific output on a group basis
• several bundled payment contracts in place with Germany’s largest insurers, with quality benchmarks of > 95% for urinary continence and > 97% for erectile function and many more

In the meantime the Martini clinic has become the world’s biggest prostate cancer center, it has reached world-class standards and outcome for patients and is most likely THE choice for prostate cancer patients to go for if they can.

Although many healthcare systems are beginning to embrace the concept of value-based healthcare, several obstacles still need to be addressed. One of the critical challenges is defining what “value” means in healthcare. Additionally, while patient centricity is a crucial component, it is not yet established uniformly across all healthcare systems, patients also often do not have equal access to care. Globally, various programs have been developed and are continually evolving, but achieving systematic implementation in healthcare systems requires convincing all stakeholders, establishing optimal reimbursement schemes, or integrating electronic medical records while also effectively analyzing and utilizing corresponding data. We at Alcimed will keep you informed about future developments. Don’t hesitate to contact our team!

About the author, 

Volker Bischoff, Great Explorer Oncology in Alcimed’s Life Sciences team in Germany