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Editor's Page

Where We Are With Value Assessment & Innovative Care and Reimbursement Models

Authored by

Winston Wong, PharmD, Editor-in-Chief


J Clin Pathways. 2018;4(10):18.

WongAs the US health care system continues to evolve to value-based care delivery and reimbursement, questions of how to determine what treatments and models produce the most value is imperative. Stakeholders need to begin utilizing frameworks or algorithms for assessing the value of a specific therapy option, innovative care models such as the Oncology Care Model (OCM), and alternative payment models. The articles in this issue discuss the challenges of designing and implementing these emerging models and frameworks.

Personalized medicine and driving for value are key directions in health care today. They can support one another; in fact, by narrowing a medicine’s use to when it is most effective is a wise use of resources. Robert W Dubois, MD, PhD, details the range of issues to consider when attempting to successfully integrate personalized medicine and value frameworks.

Much like value frameworks assess value for a typical patient, current quality measures usually assess performance against a standard of care for a typical patient rather than the specific patient receiving care. Using Dr Dubois’ commentary as a jumping off point, Tom Valuck, MD, JD, and Russ Montgomery, PhD, MHS, assert that changes to quality measures are needed to encourage consideration of patients’ goals for care and wider use of shared decision-making at the point of care in order to establish a more patient-centered approach to value assessment.

When launched in 2016, the OCM represented one of the most advanced efforts yet to migrate health care delivery from fee-for-service to fee-for-value. Since then, much has been written about potential strengths and weaknesses of the model; new to the discussion is the second performance period (PP2) data, provided to participants in August 2018. Charles Saunders, MD, draws on PP2 data from and experience with a large cohort of OCM practices working with Integra Connect to highlight the primary challenges that arose once practices were confronted with their performance assessments.

The fourth feature in this issue focuses on alternative payment models, specifically, bundled payments. Early evidence suggests that, under episode-based incentives, clinicians and organizations can improve the value of care for certain episodes. Joshua M Liao, MD, MSc, FACP, explains how the continued emergence of bundled payments as a cornerstone payment model poses several implications for pathway initiatives.

A new regular section in this issue is a summary of the Clinical Pathways Forum, which meets via online conference calls quarterly. The Forum is made up of more than 12 cancer institutions who are using pathways in their practices and are seeking to connect with and learn from others in the same pursuit. These columns will summarize each call for readers’ benefit.

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