Transforming Oncology: The Shift to Value-Based Care

The Current Landscape of Oncology Care

It has become evident that the traditional oncology care delivery system has been encountering significant challenges. Increasingly expensive new drug treatments, complications with delivering care in a timely, efficient manner, and a fragmented care experience has made it nearly impossible for cancer patients to effectively navigate their care journey. Health plans and risk-bearing entities are grappling with ensuring high-quality, cost-effective cancer care for their patients as they in turn face:

• Rising costs of cancer treatment | Cancer care costs have risen from $57 billion in 2001 to over $200 billion today.¹ This ranges from drug costs to unnecessary ED visits/hospitalizations and beyond.

• Variability in treatment quality and outcomes | The quality of cancer care varies between providers and treatment settings, which creates inefficiencies and gaps in patient care and leads to poor outcomes.

• Limited patient support | Many patients with health-related social needs face barriers to care, such as a lack of transportation to appointments or an inability to afford treatment. This may lead to gaps and delays in care, resulting in poor outcomes and a sub-par patient experience.

These challenges contribute to a fragmented care experience, leading to worsening patient outcomes and increases in the total cost of care. As costs continue to sky-rocket, addressing these issues has become imperative to ensure better outcomes for individuals living with cancer. 

However, there’s hope on the horizon for payers and providers who are embracing value-based oncology care.  

The Shift Towards Value-Based Oncology Care

Value-Based Care (VBC) is a healthcare delivery model where providers are paid based on improvement in patient outcomes and reductions in cost. Providers focus on the quality of the patient's care rather than the quantity of services provided, and are incentivized based on improvements in agreed-upon outcomes (e.g. patient satisfaction, reduction in acute care visits, etc.). Additionally, payers in VBC arrangements work with providers to set clear goals, design payment incentive programs, and monitor the performance of patients’ care plans.

The benefits of value-based oncology care extend across patients, providers, and risk-bearing groups:

• Improved outcomes. Value-based care arrangements prioritize evidence-based care and patient-centered approaches by incentivizing providers to adhere to quality metrics, integrate services across the cancer care continuum, and offer preventive and supportive services, resulting in better outcomes.

• Enhanced cancer patient experience. In value-based care arrangements, providers are motivated to prioritize whole-person care that is personalized to the patient’s unique needs. By keeping patients at the center of care, value-based care models promote a more personalized healthcare experience, leading to increased patient satisfaction and engagement.

• Financial sustainability for health plans and risk-bearing entities. VBC models incentivize providers to embrace efficient practices, minimize waste, and engage in preventative care that reduces potential unnecessary services/treatments, resulting in cost reductions for health plans and risk-bearing entities, as well as for patients. 

These benefits are rewarding for the whole healthcare system, but given how entrenched the fee-for-service model is in our oncology care delivery system, value-based care is not always an easy shift.

Challenges in Implementing Value-Based Oncology Care

Challenges in implementing value-based oncology care are multifaceted and range from resource allocation to data measurement. Here are some of the top hurdles faced in operationalizing value-based care in oncology:

• Lack of resourcing and incentives | Successfully transitioning to value-based care demands substantial investments of time, money, and staff. Many practices are unable to allocate adequate resources to self-navigate this transition effectively.

• Not a one-size-fits-all solution | Value-based oncology care cannot be standardized across the cancer patient population. Cancer care plans are unique to the patient and require comprehensive, detailed support across specialty expertise.

• Limited data and analytics | Robust patient information and measurement is crucial for assessing the success of value-based care initiatives. However, the lack of comprehensive data and analytics tools hinders providers’ and payer’s ability to accurately measure outcomes and make informed decisions.

Solutions for Overcoming Challenges

To address the challenges associated with implementing value-based oncology care, it's crucial to tap into resources and strategies that enable payers and providers to navigate these complexities effectively:

• Partnering with value-based care enablers | Value-based care enablers like Thyme Care collaborate with health plans and risk-bearing entities to take on aggregate risk across practices and patient pools, and create business models and incentives that allow wraparound services outside of the fee-for-service compensation model.  

• Bridging the care gap | For providers, a comprehensive, effective cancer navigation solution provides wraparound patient support outside the clinic, allowing them to fully focus on patient care. For health plans and risk-bearing entities, their members can access an end-to-end oncology solution that addresses both clinical and non-clinical needs throughout the cancer journey, improving patient experience and lowering total cost of care.

• Access to high quality data and analytics | Operationalizing value-based care programs requires access to organized, thoughtful data and analytics. By leveraging advanced analytics tools and insights (commonly provided by value-based care enablers), health plans and other risk-bearing organizations can track performance, measure success in terms of outcomes and cost savings, and make informed decisions to drive continuous improvement.

By implementing these solutions, healthcare organizations can overcome the challenges associated with value-based oncology care and pave the way for a brighter future for oncology.

Embracing the Future of Value-Based Oncology Care 

The shift towards value-based oncology care presents a promising opportunity to transform how cancer is delivered by focusing on patient outcomes, enhancing care coordination, and ensuring financial sustainability for health plans and risk-bearing entities. While there are challenges in implementing value-based care in oncology, strategic partnerships with value-based care enablers like Thyme Care offer solutions to overcome these hurdles. Thyme Care's expertise and capabilities enable providers to navigate the complexities of value-based oncology care effectively. We invite health plans and risk-bearing groups to embrace the transformative potential of value-based care by partnering with Thyme Care. Together, we can improve cancer care delivery and outcomes for individuals living with cancer.

Connect with Thyme Care today to learn more about how we can support your organization's journey towards value-based oncology care.

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778988/