Stephen “Fred” Divers, MD: Hi, I am Fred Divers. I’m a medical oncologist in Arkansas and part of the American Oncology Network and a COA board member.
OBR: What is value-based care in oncology?
Dr. Divers: I think value-based care takes on many forms. But in short, it really means care where we take into account both the quality provided but also the cost of the care administered. I think the definition of value-based care is the quality of the care divided by the cost. Unfortunately, a lot of times, we focus on the denominator there rather than the numerator as much as we should. But really, it is an arrangement where perhaps there’s some risk-sharing in the cost of patient care. We can see a continued evolution from the traditional fee-for-service model to more of a value-based model.
OBR: What are some of the ethical considerations when it comes to value-based care?
Dr. Divers: When we start thinking about capitation of care and allocation of healthcare resources to patients, I don’t think anybody wants to play God and decide who does and doesn’t receive care. That’s where the ethics come in. I think when you have multiple stakeholders at the table thinking about what the cost drivers here might be, we want to make sure that we keep the patient front and center, so care is not rationed or withheld in the interest of cost.
I mean, we’ve seen a lot of concerns about that in papers and in the media recently, about public equity interest in companies and whether that would change their decision making. I think the real key in all value-based and quality care is making sure the patient remains at the center, trying to be a good steward of the healthcare dollars – and remain conscious of that – but never having that really drive the decision process.
OBR: How do you feel technology can address some of those issues?
Dr. Divers: We think about “If you’ve got this many dollars in a bucket and this many patients, everybody gets X.” And I don’t think that’s really the right tactic. I think we have some therapies that are super high value. And you look at the response and the survival, and the hazard ratio there is 0.2. I mean, these offer immense value to patients, and we want to make sure we find those patients and make sure we deliver the right care to the right patient at the right time.
And we think, therein lies where your value is: not so much in allocation or capitation of resources but in identification of the appropriate resource to the appropriate patient at the appropriate time during their cancer journey. That context is critical. In order to get to that context, you have to have pretty deeply curated data on that patient journey. So to get to that point, that’s where some [technology] comes into play. You have to have data analytics to help you execute that strategy.
OBR: What do you see as the future for value-based care models?
Dr. Divers: When we talk about value-based care, I think the Oncology Care Model (OCM) was probably the initial [model]. And then we took a year’s sabbatical, and now we have the Enhancing Oncology Model (EOM) for the Medicare population. Truthfully, all private payers and advantage plans are evolving to that. In reality, some of those may not have downside risk. In fact, most of them do not. It’s more of a performance-based payment to the upside.
I think as we see these primary care groups assuming delegated risk, we’re going to see more and more of the “private pay” patients who are lumped into some sort of shared savings bucket. I think that is going to continue to grow. You name a payer out there, and they’re trying to figure this out right now. I think if we go to them with intelligent decisions and what we learned from OCM and what we’ve learned from EOM, it would be really helpful so that they perhaps avoid the pitfalls of setting up a value-based plan that really doesn’t serve the patient well or doesn’t result in the intended outcome of cost savings. We see these negative externalities in models all the time, and they’re unintended, but they still occur. I think it’s a learning process between payer, patient, and provider along that way.
OBR: How do you see value-based care working at your institution?
Dr. Divers: We’ve basically dedicated a huge chunk of resources to this on the operations side. We have a chief strategy and innovation officer who is payer-facing and a whole team behind that person. I think it’s to drive fruitful discussions [with] the payer. I think sometimes we do bring in third parties to help bridge that gap between the provider and the payer, and I think those are helpful. Historically, practices have had providers, nurses, intake staff, and financial staff. But now it’s more payer-relations staff and care navigation on the patient side to make sure that we’re executing in these value-based arrangements and keeping [patients] out of low-value, high-cost scenarios such as emergency room [visits] and hospital stays and so forth.
This transcript has been lightly edited for clarity.
