Value-based care: an update from Dr. Ray Page of Center for Cancer and Blood Disorders

Stephanie GingerPatient Relationship Management, Value-based Care

A recent event hosted by AJMC’s Institute for Value-based Medicine focused on advancing quality in oncology care, the speakers included Dr. Ray Page of the Center for Cancer and Blood Disorders (CCBD) in Fort Worth, Texas. Dr. Page and his practice have led the way in the move to value-based care. His practice has been participating in pilot programs like the COME HOME project for many years. CCBD was also an early adopter of Navigating Cancer’s patient relationship management platform as part of the practice’s transformation to deliver high quality, coordinated care while lowering the total cost of care.

In his presentation he described the challenges for cancer providers in particular as they work to shift to value-based care. Those, of course, include the growing cost of already expensive therapies and administrative burdens, but he also spent some time discussing the complex formula CMS’ Oncology Care Model uses to calculate value.

Why are so many community oncology practices closing their doors? Historically they’ve been in a fee for service model with a margin on the price of drugs to stay in business. As the price of drugs has gone up exponentially practices have to make a substantial financial investment to buy the drugs and put the practice at risk. The traditional buy/bill system has become too risky.

The Collision of Fee-for-Service and Value-based Care

It’s become very difficult to be in both worlds and remain viable. Historically, patient and physician referrals indicated value, but now the government is putting value into an equation to determine value and it’s extremely complicated…66 pages long. What’s not in the equation is the art of medicine – how you treat the patient, compassion, molecularly defined treatments, personalized medicine, the twelve social determinants of health and more. Dr. Page’s question to the audience, “Do you really trust your future payments on formulas that are not fully understood?”

Essentials for Success in the Current Cancer Care Landscape

Fee for service is widely considered unsustainable and there are considerable challenges with the cost of drugs. Dr. Page pointed out that without shared risk, the result can be intense prior authorization requirements, which was the number one administrative burden for physicians according to an ASCO survey.

There are important factors to succeeding in value-based care including clinical pathways, proactive triage and symptom management which includes comprehensive management of high risk patients. CCBD has partnered with Navigating Cancer to leverage technology for triage and symptom management. They have also centralized their triage nurses to standardize the intervention that is called for whether is a prescription refill and a more serious issue that requires a same day appointment. And as a member of QCCA, they have been able to share what their successes with other practices in the association as well as learn from them.

They have even been able to quantify the success of these tactics. The Journal of Oncology Practice will soon publish “Reducing Cancer Costs Through Symptom Management and Triage Pathways” which will detail significant saving both CCBD and Northwest Medical Specialties have realized since implementing Navigating Cancer’s Patient Relationship Management platform.

Another key part of succeeding in risk-based arrangements is effective navigation. CCBD’s Nurse Navigators are essential for setting expectations of the journey for patients, ensuring patients understand the triage process, who they should call if an issue arises, how to access support services and documenting advanced directives.

CCBD is also using a risk stratification tool – leveraging artificial intelligence to identify the most high risk patients. This is helping them provide appropriate support. For instance, if a patient is at risk for depression, the care team can provide added psychosocial support.

Challenges Ahead

Dr. Page recognized that his practice is still learning. They need to better maximizing evaluation and management coding. He would like to participate more in telemedicine and get better at data analysis. The next steps for value-based care include aligning incentives for all healthcare providers, continuing to ask drug manufacturers to prove the value of their treatments and building new APMs that continue to enhance care and create value.

It’s exciting to watch this innovative practice evolve and transform the care it provides to its patients. We are fortunate to have CCBD as a clinical partner. The cancer care community is also going to benefit due to their collaborative philosophy and commitment to improving cancer care.

Interested in learning about Navigating Cancer’s technology and how CCBD has leveraged it in their practice to improve the care they provide and reduce costs? Contact us today!